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General NPI Number Information
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NPI Number | 1558033548
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Entity Type | Organization
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Legal Business Name | AMBASSADOR SOARS SUPPORTIVE LIVING AND TRANSPORTATION SERVICES, INC
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Dates
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Enumeration Date | 09/29/2021
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Last Update Date | 09/29/2021
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Provider Practice Location Address
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Address Line | 5006 TROUBLE CREEK RD STE 101
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652-4937
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Country | US
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Telephone | 727-557-5995
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Fax |
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Provider Business Mailing Address
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Address Line | 5317 ANHINGA TRL
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City | NEW PORT RICHEY
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State | FL
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Zip | 34653-7032
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Country | US
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Telephone | 727-557-5995
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DWAIMEON M JORDAN
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Credential |
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Telephone | 727-557-5995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health 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 | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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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 | 372600000X
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Taxonomy Name | Adult Companion
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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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