1710579321 NPI number — AMBASSADOR HEALTH SERVICES INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710579321 NPI number — AMBASSADOR HEALTH SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMBASSADOR HEALTH SERVICES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710579321
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3333 S CONGRESS AVE STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DELRAY BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33445-7300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-274-4149
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 E GOVERNMENT ST STE 10
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENSACOLA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32502-6018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-331-7730
Provider Business Practice Location Address Fax Number:
561-450-1443
Provider Enumeration Date:
02/04/2021

Additional Information

Authorized Official

Authorized Official Last Name:
HUNTER
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
MICHELLE
Authorized Official Title or Position:
DIRECTOR OF CONTRACT DEVELOPMENT
Authorized Official Telephone Number:
727-888-2844

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 110386500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 299995274 . This is a "AGENCY FOR HEALTH CARE ADMINISTRATION" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 110386500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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