Provider Demographics
NPI:1619093226
Name:AMBERCARE HOSPICE INC.
Entity Type:Organization
Organization Name:AMBERCARE HOSPICE INC.
Other - Org Name:HOPICE
Other - Org Type:Other Name
Authorized Official - Title/Position:VP NATIONAL CONTRACTS
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMARICH
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MBA, MS
Authorized Official - Phone:630-296-3530
Mailing Address - Street 1:2300 WARRENVILLE RD.
Mailing Address - Street 2:STE 100
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1765
Mailing Address - Country:US
Mailing Address - Phone:630-296-3400
Mailing Address - Fax:304-872-7136
Practice Address - Street 1:788 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310
Practice Address - Country:US
Practice Address - Phone:575-437-0596
Practice Address - Fax:575-437-1968
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADDUS HEALTHCARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-22
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6119251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM321514Medicare ID - Type Unspecified
NM321514Medicare ID - Type Unspecified