Provider Demographics
NPI:1336688258
Name:AMBITIOUS QUALITY CARE ASSISTED LIVING
Entity Type:Organization
Organization Name:AMBITIOUS QUALITY CARE ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGILL
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:863-242-8444
Mailing Address - Street 1:PO BOX 545
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33882-0545
Mailing Address - Country:US
Mailing Address - Phone:863-242-8444
Mailing Address - Fax:863-875-4766
Practice Address - Street 1:3939 COUNTRY PL APT C
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-1519
Practice Address - Country:US
Practice Address - Phone:863-242-8444
Practice Address - Fax:863-875-4766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11988310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility