Provider Demographics
NPI:1326094855
Name:AMBROSE REHABILITATION CONSULTANTS, PLLC
Entity Type:Organization
Organization Name:AMBROSE REHABILITATION CONSULTANTS, PLLC
Other - Org Name:AMBROSE COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:PINER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:517-648-2939
Mailing Address - Street 1:2109 HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-1700
Mailing Address - Country:US
Mailing Address - Phone:517-648-2939
Mailing Address - Fax:517-575-0253
Practice Address - Street 1:2109 HAMILTON RD
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-1700
Practice Address - Country:US
Practice Address - Phone:517-648-2939
Practice Address - Fax:517-575-0253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801067102261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)