=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962033951
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMBASSADORE HEALTH CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2020
-----------------------------------------------------
Last Update Date | 11/04/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17100 PIONEER BLVD STE 270
-----------------------------------------------------
City | ARTESIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90701-2736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-409-4110
-----------------------------------------------------
Fax | 562-286-8950
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17100 PIONEER BLVD STE 270
-----------------------------------------------------
City | ARTESIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90701-2736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-409-4110
-----------------------------------------------------
Fax | 562-286-8950
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | EMMALYN V ALCANTARA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 562-409-4110
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------