Healthcare Provider Details

I. General information

NPI: 1306688163
Provider Name (Legal Business Name): AMBITION FOR CHANGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 06/11/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 DARTMOUTH STREET
HOOKSETT NH
03106
US

IV. Provider business mailing address

5 DARTMOUTH STREET
HOOKSETT NH
03106
US

V. Phone/Fax

Practice location:
  • Phone: 443-856-8386
  • Fax:
Mailing address:
  • Phone: 443-856-8386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. RABIN SANGROULA
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 443-856-8386