=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851194922
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARDENT CIRCLE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2025
-----------------------------------------------------
Last Update Date | 04/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 309 COURT AVE STE 200
-----------------------------------------------------
City | DES MOINES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50309-2230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-814-7824
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3030 LAKE ARTHUR DR APT 26
-----------------------------------------------------
City | PORT ARTHUR
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77642-4442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-239-8228
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO OF ARDENT CIRICLELLC
-----------------------------------------------------
Name | OCTAVIA S SKAKUN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 936-239-8228
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 385H00000X
-----------------------------------------------------
Taxonomy Name | Respite Care
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------