Provider Demographics
NPI:1942614789
Name:AMBASSADOR VETERANS SERVICES OF PUERTO RICO
Entity Type:Organization
Organization Name:AMBASSADOR VETERANS SERVICES OF PUERTO RICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SADLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-590-3573
Mailing Address - Street 1:CARRETERA 592 KM 5.6
Mailing Address - Street 2:BO. AMUELAS #115
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-2409
Mailing Address - Country:US
Mailing Address - Phone:787-837-6574
Mailing Address - Fax:787-837-3943
Practice Address - Street 1:CARRETERA 592 KM 5.6
Practice Address - Street 2:BO. AMUELAS #115
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-2409
Practice Address - Country:US
Practice Address - Phone:787-837-6574
Practice Address - Fax:787-837-3943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-19
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility