Healthcare Provider Details

I. General information

NPI: 1194334466
Provider Name (Legal Business Name): AMBASSADOR HOME CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118080 BUSTLETON AV SUITE 301
PHILADELPHIA PA
19116
US

IV. Provider business mailing address

626 JACKSONVILLE RD
WARMINSTER PA
18974-4872
US

V. Phone/Fax

Practice location:
  • Phone: 215-486-1080
  • Fax: 215-613-8788
Mailing address:
  • Phone: 267-770-6729
  • Fax: 215-613-8788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARINA AMERKHANOVA
Title or Position: ADMINISTRATOR
Credential:
Phone: 267-258-3396