Provider Demographics
NPI:1457763989
Name:AMBROSIA HEALTHCARE INC
Entity Type:Organization
Organization Name:AMBROSIA HEALTHCARE INC
Other - Org Name:AMBROSIA HEALTHCARE INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MANISHKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-691-2000
Mailing Address - Street 1:PO BOX 10203
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92255-0203
Mailing Address - Country:US
Mailing Address - Phone:760-691-2000
Mailing Address - Fax:888-505-3006
Practice Address - Street 1:75060 GERALD FORD DR STE 2
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-2080
Practice Address - Country:US
Practice Address - Phone:760-691-2000
Practice Address - Fax:888-505-3006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-02
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X, 3336C0004X, 3336L0003X, 3336S0011X
CAPHY518683336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146736OtherPK
7280550001Medicare NSC