Healthcare Provider Details

I. General information

NPI: 1396566972
Provider Name (Legal Business Name): AMBACO LIMITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 10/17/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4554 N. BROADWAY STREET SUITE 314
CHICAGO IL
60640-5621
US

IV. Provider business mailing address

4554 N BROADWAY STREET SUITE 314
CHICAGO IL
60640-5621
US

V. Phone/Fax

Practice location:
  • Phone: 773-784-5669
  • Fax:
Mailing address:
  • Phone: 773-784-5669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MR. EDDIE NGOZI NWOSU
Title or Position: PRESIDENT
Credential:
Phone: 773-784-5669