Provider Demographics
NPI:1821141821
Name:AMBUCARE, LLC
Entity Type:Organization
Organization Name:AMBUCARE, LLC
Other - Org Name:AMBUCARE, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF REVENUE INTEGRATION OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:JEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-597-4911
Mailing Address - Street 1:PO BOX 7179
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60197-7179
Mailing Address - Country:US
Mailing Address - Phone:844-597-4911
Mailing Address - Fax:866-687-2796
Practice Address - Street 1:1196 HIGHTOWER RD
Practice Address - Street 2:
Practice Address - City:BREMEN
Practice Address - State:GA
Practice Address - Zip Code:30110-4382
Practice Address - Country:US
Practice Address - Phone:770-537-1946
Practice Address - Fax:770-537-2744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-21
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA071-043416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000652308AMedicaid
GA59RCBHHMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER