MEDICARE: AMBASSADOR HEALTH CARE OF BRADY INC

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	314000000X	Skilled Nursing Facility	115035	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770670937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMBASSADOR HEALTH CARE OF BRADY INC

Provider Business Mailing Address
First Line	:	1771 INTERNATIONAL PKWY
Second Line	:	SUITE 121
City	:	RICHARDSON
State	:	TX
Zip	:	75081-1897
Country	:	US
Telephone Number	:	972-479-0844
Fax Number	:

Provider Business Practice Location Address
First Line	:	1615 HILLENDAHL BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-3413
Country	:	US
Telephone Number	:	713-365-0561
Fax Number	:

Authorized Official
Title or Position	:	AR MANAGER
Name	:	MS. THERESA L LOFTICE
Credential	:
Telephone Number	:	972-479-0844

Provider Enumeration Date	:	10/09/2006
Last Update Date	:	08/22/2020

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