Healthcare Provider Details

I. General information

NPI: 1740143833
Provider Name (Legal Business Name): AMBITIOUS HEART HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1954 E WASHINGTON AVE APT 17
MADISON WI
53704-5260
US

IV. Provider business mailing address

1954 E WASHINGTON AVE APT 17
MADISON WI
53704-5260
US

V. Phone/Fax

Practice location:
  • Phone: 608-961-5079
  • Fax:
Mailing address:
  • Phone: 608-961-5079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TAMISHA PEARNELL
Title or Position: OWNER
Credential:
Phone: 608-961-5079