=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992812515
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMBAR HOME HEALTH AGENCY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2006
-----------------------------------------------------
Last Update Date | 10/12/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 633 NE 167TH ST STE 614
-----------------------------------------------------
City | NORTH MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33162-2444
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-690-4243
-----------------------------------------------------
Fax | 305-690-5883
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 633 NE 167TH ST STE 614
-----------------------------------------------------
City | NORTH MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33162-2444
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-690-4243
-----------------------------------------------------
Fax | 305-690-5883
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. MARITZA HERNANDEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-690-4243
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 299991839
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------