Healthcare Provider Details

I. General information

NPI: 1417674490
Provider Name (Legal Business Name): AMBEMAA HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2022
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BUSINESS PKWY # A-D
PIEDMONT SC
29673-6707
US

IV. Provider business mailing address

12 WHITETHORN LN
GREENVILLE SC
29607-5676
US

V. Phone/Fax

Practice location:
  • Phone: 973-462-4429
  • Fax: 864-671-0301
Mailing address:
  • Phone: 973-462-4429
  • Fax: 864-671-0301

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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. SAMIR PATEL
Title or Position: OWNER ADMIN
Credential: RPH
Phone: 973-462-4429