{
"Npi": {
"NPI": "1023508405",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "AMBASSADOR HEALTH SERVICES, INC.",
"ParentOrgTIN": null,
"OrgName": "AMBASSADOR HEALTH SERVICES, INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3333 S CONGRESS AVE STE 100",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DELRAY BEACH",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33445-7300",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "352-701-1723",
"MailingAddressFaxNumber": "352-701-1770",
"FirstLinePracticeLocationAddress": "10487 SPRING HILL DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SPRING HILL",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "34608-5045",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "352-701-1723",
"PracticeLocationAddressFaxNumber": "352-701-1770",
"EnumerationDate": "05/11/2018",
"LastUpdateDate": "08/01/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HUNTER",
"AuthorizedOfficialFirstName": "KIMBERLY",
"AuthorizedOfficialMiddleName": "MICHELLE",
"AuthorizedOfficialTitle": "DIRECTOR OF CONTRACT DEVLOPMENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "727-888-2844",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "253Z00000X",
"TaxonomyName": "In Home Supportive Care Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}