Provider Demographics
NPI:1356999361
Name:AMBROSE ETERNITY HOME SERVICES, LLC.
Entity type:Organization
Organization Name:AMBROSE ETERNITY HOME SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ARREDONDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-454-7501
Mailing Address - Street 1:3505 BOCA CHICA BLVD.
Mailing Address - Street 2:STE. 205
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521
Mailing Address - Country:US
Mailing Address - Phone:956-454-7501
Mailing Address - Fax:866-475-9389
Practice Address - Street 1:3505 BOCA CHICA BLVD.
Practice Address - Street 2:STE. 205
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521
Practice Address - Country:US
Practice Address - Phone:956-454-7501
Practice Address - Fax:866-475-9389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-03
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty