MEDICARE: ARDOR HOME CARE REGISTRY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251J00000X	Nursing Care Agency	30211197	FL
2	253Z00000X	In Home Supportive Care Agency	30211197	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336516806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARDOR HOME CARE REGISTRY, INC.

Provider Business Mailing Address
First Line	:	258 SE 6TH AVE STE 5&6
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-5259
Country	:	US
Telephone Number	:	561-279-9885
Fax Number	:

Provider Business Practice Location Address
First Line	:	258 SE 6TH AVE STE 5&6
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-5259
Country	:	US
Telephone Number	:	561-279-9885
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	LISA SUSAN SPITULNIK
Credential	:
Telephone Number	:	561-279-9885

Provider Enumeration Date	:	08/31/2015
Last Update Date	:	09/11/2015

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Directions to “ARDOR HOME CARE REGISTRY, INC. ” Practice Location

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