Provider Demographics
NPI:1235259698
Name:AMBLECARE, INC.
Entity Type:Organization
Organization Name:AMBLECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DONNELL
Authorized Official - Middle Name:BOBBY
Authorized Official - Last Name:BUCKNER
Authorized Official - Suffix:
Authorized Official - Credentials:BAQP
Authorized Official - Phone:252-747-5252
Mailing Address - Street 1:1 INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:SNOW HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28580-1334
Mailing Address - Country:US
Mailing Address - Phone:252-747-5252
Mailing Address - Fax:252-747-4244
Practice Address - Street 1:1 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:SNOW HILL
Practice Address - State:NC
Practice Address - Zip Code:28580-1334
Practice Address - Country:US
Practice Address - Phone:252-747-5252
Practice Address - Fax:252-747-4244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408580Medicaid