=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659730570
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMBASSADOR HEALTH SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2016
-----------------------------------------------------
Last Update Date | 04/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 W LUCERNE CIR STE 500
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32801-3794
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-768-0958
-----------------------------------------------------
Fax | 321-684-5203
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3333 S CONGRESS AVE STE 100
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33445-7300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-274-4148
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF CONTRACT DEVELOPMENT
-----------------------------------------------------
Name | KIMBERLY MICHELLE HUNTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 727-888-2844
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------