Provider Demographics
NPI:1639756752
Name:AMBASSADOR CARE HOME
Entity Type:Organization
Organization Name:AMBASSADOR CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RAUFAT
Authorized Official - Middle Name:
Authorized Official - Last Name:IKHARO-UMARU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-812-2188
Mailing Address - Street 1:145 BEEDE WAY
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-1827
Mailing Address - Country:US
Mailing Address - Phone:510-812-2188
Mailing Address - Fax:
Practice Address - Street 1:145 BEEDE WAY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-1827
Practice Address - Country:US
Practice Address - Phone:510-812-2188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility