Provider Demographics
NPI:1851194922
Name:ARDENT CIRCLE LLC
Entity type:Organization
Organization Name:ARDENT CIRCLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO OF ARDENT CIRICLELLC
Authorized Official - Prefix:
Authorized Official - First Name:OCTAVIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SKAKUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-239-8228
Mailing Address - Street 1:3030 LAKE ARTHUR DR APT 26
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-4442
Mailing Address - Country:US
Mailing Address - Phone:936-239-8228
Mailing Address - Fax:
Practice Address - Street 1:309 COURT AVE STE 200
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-2230
Practice Address - Country:US
Practice Address - Phone:803-814-7824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-01
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care