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General NPI Number Information
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NPI Number | 1104561331
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Entity Type | Organization
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Legal Business Name | AMBROSE CUBED LLC
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Dates
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Enumeration Date | 05/02/2022
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Last Update Date | 06/29/2022
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Provider Practice Location Address
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Address Line | 6780 HUDSPETH RD
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City | HARRISBURG
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State | NC
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Zip | 28075-5006
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Country | US
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Telephone | 704-907-4436
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Fax |
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Provider Business Mailing Address
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Address Line | 6780 HUDSPETH RD
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City | HARRISBURG
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State | NC
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Zip | 28075-5006
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Country | US
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Telephone | 704-907-4436
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | WILLIAM SIMPSON
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Credential |
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Telephone | 704-907-4436
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #4
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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 #5
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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