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General NPI Number Information
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NPI Number | 1336688258
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Entity Type | Organization
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Legal Business Name | AMBITIOUS QUALITY CARE ASSISTED LIVING
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Dates
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Enumeration Date | 02/13/2017
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Last Update Date | 02/13/2017
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Provider Practice Location Address
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Address Line | 3939 COUNTRY PL APT C
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City | WINTER HAVEN
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State | FL
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Zip | 33880-1519
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Country | US
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Telephone | 863-242-8444
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Fax | 863-875-4766
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Provider Business Mailing Address
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Address Line | PO BOX 545
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City | WINTER HAVEN
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State | FL
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Zip | 33882-0545
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Country | US
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Telephone | 863-242-8444
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Fax | 863-875-4766
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MIRIAM MCGILL
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Credential | MBA
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Telephone | 863-242-8444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 11988
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License Number State | FL
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