=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699015719
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARDENCY PERSONAL CARE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2013
-----------------------------------------------------
Last Update Date | 01/10/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20831 TREBEC BLVD
-----------------------------------------------------
City | EUCLID
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44119-1817
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-338-2568
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4441 ANDERSON RD
-----------------------------------------------------
City | SOUTH EUCLID
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44121-3801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MISS NIIOKCA REED
-----------------------------------------------------
Credential | LSW, PCS
-----------------------------------------------------
Telephone | 216-338-2568
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------