MEDICARE: AMBAH CARE COMMUNITY SERVICE 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1306697826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMBAH CARE COMMUNITY SERVICE LLC

Provider Business Mailing Address
First Line	:	1393 GREENCROFT RD
Second Line	:
City	:	GAHANNA
State	:	OH
Zip	:	43230-1781
Country	:	US
Telephone Number	:	614-649-4550
Fax Number	:	614-413-4727

Provider Business Practice Location Address
First Line	:	1393 GREENCROFT RD
Second Line	:
City	:	GAHANNA
State	:	OH
Zip	:	43230-1781
Country	:	US
Telephone Number	:	614-649-4550
Fax Number	:	614-413-4727

Authorized Official
Title or Position	:	OWNER
Name	:	CHERNOR A BAH
Credential	:
Telephone Number	:	614-649-4550

Provider Enumeration Date	:	04/01/2024
Last Update Date	:	04/01/2024

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