MEDICARE: AMBASSADORS, 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	253Z00000X	In Home Supportive Care Agency	009475	TX

General Provider Information

NPI Number	:	1205065836
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMBASSADORS, LLC

Provider Business Mailing Address
First Line	:	2118 OAKDALE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-7410
Country	:	US
Telephone Number	:	713-521-2221
Fax Number	:	866-873-9006

Provider Business Practice Location Address
First Line	:	2118 OAKDALE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-7410
Country	:	US
Telephone Number	:	713-521-2221
Fax Number	:	866-873-9006

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VICTORIA A BRYANT
Credential	:	PHARMD
Telephone Number	:	713-521-2221

Provider Enumeration Date	:	07/02/2009
Last Update Date	:	07/02/2009

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