Provider Demographics
NPI:1023477940
Name:AMBASSADOR HEALTH SERVICES, INC
Entity type:Organization
Organization Name:AMBASSADOR HEALTH SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CONTRACT DEVELMENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-888-2844
Mailing Address - Street 1:3333 S CONGRESS AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-7300
Mailing Address - Country:US
Mailing Address - Phone:561-274-4149
Mailing Address - Fax:
Practice Address - Street 1:4720 SALISBURY RD STE 115
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6101
Practice Address - Country:US
Practice Address - Phone:386-271-4372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMBASSADOR HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-19
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017349600Medicaid
FL022602400Medicaid
FL299994541OtherAHCA LICENSE