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General NPI Number Information
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NPI Number | 1073059663
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Entity Type | Organization
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Legal Business Name | AMBITIOUS PROVIDER SERVICES, INC.
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Dates
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Enumeration Date | 01/06/2017
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Last Update Date | 01/06/2017
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Provider Practice Location Address
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Address Line | 8035 E R L THORNTON FWY 468
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City | DALLAS
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State | TX
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Zip | 75228-7018
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Country | US
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Telephone | 469-735-3395
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Fax | 469-941-4158
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Provider Business Mailing Address
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Address Line | 8035 E. RLT. FRWY. 468
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City | DALLAS
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State | TX
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Zip | 75228-1020
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Country | US
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Telephone | 469-735-3395
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Fax | 469-941-4158
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Authorized Official
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Title or Position | PROGRAM MANAGER
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Name | LARRYMI DANIELLE MATHIS
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Credential |
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Telephone | 469-735-3395
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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