MEDICARE: ARDMORE HOME CARE LLC

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	310400000X	Assisted Living Facility	197608676	CA

General Provider Information

NPI Number	:	1578947347
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARDMORE HOME CARE LLC

Provider Business Mailing Address
First Line	:	128 N ARDMORE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-4502
Country	:	US
Telephone Number	:	213-674-7046
Fax Number	:	213-674-7046

Provider Business Practice Location Address
First Line	:	128 N ARDMORE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-4502
Country	:	US
Telephone Number	:	213-674-7046
Fax Number	:	213-674-7046

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. MARIA ELIZABETH SARMIENTO
Credential	:	RN
Telephone Number	:	213-255-8390

Provider Enumeration Date	:	07/12/2015
Last Update Date	:	07/12/2015

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