Provider Demographics
NPI:1497284749
Name:ARDOR MEDICAL TRANSPORTATION
Entity Type:Organization
Organization Name:ARDOR MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:NAYCORA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAUNTLEROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-752-4692
Mailing Address - Street 1:7236 GREENHAVEN DR #108
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831
Mailing Address - Country:US
Mailing Address - Phone:916-752-4692
Mailing Address - Fax:
Practice Address - Street 1:7236 GREENHAVEN DR APT 108
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-3546
Practice Address - Country:US
Practice Address - Phone:916-752-4692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker