Provider Demographics
NPI:1003855883
Name:AMBUSERVE, INC.
Entity Type:Organization
Organization Name:AMBUSERVE, INC.
Other - Org Name:SHORELINE AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-644-0500
Mailing Address - Street 1:15105 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-1821
Mailing Address - Country:US
Mailing Address - Phone:310-644-0500
Mailing Address - Fax:310-644-4500
Practice Address - Street 1:15105 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-1821
Practice Address - Country:US
Practice Address - Phone:310-644-0500
Practice Address - Fax:310-644-4500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTE01113FMedicaid
CAZ506Medicare UPIN