MEDICARE: AMBACO LIMITED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376J00000X	Homemaker
2	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1396566972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMBACO LIMITED

Provider Business Mailing Address
First Line	:	4554 N BROADWAY STREET SUITE 314
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5621
Country	:	US
Telephone Number	:	773-784-5669
Fax Number	:

Provider Business Practice Location Address
First Line	:	4554 N. BROADWAY STREET SUITE 314
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5621
Country	:	US
Telephone Number	:	773-784-5669
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. EDDIE NGOZI NWOSU
Credential	:
Telephone Number	:	773-784-5669

Provider Enumeration Date	:	10/17/2024
Last Update Date	:	10/17/2024

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Directions to “AMBACO LIMITED ” Practice Location

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