Healthcare Provider Details

I. General information

NPI: 1912549031
Provider Name (Legal Business Name): AMBROSE CONSULTING SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2019
Last Update Date: 01/14/2020
Certification Date: 01/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10917 DULIN CREEK BLVD
CHARLOTTE NC
28215-9043
US

IV. Provider business mailing address

6231 SAINT REGIS CIR APT 303
RALEIGH NC
27606-5001
US

V. Phone/Fax

Practice location:
  • Phone: 336-215-8151
  • Fax:
Mailing address:
  • Phone: 910-734-5204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JASMINE E AMBROSE
Title or Position: PRESIDENT
Credential:
Phone: 910-734-5204