Provider Demographics
NPI:1770369217
Name:AMBONI HOMECARE
Entity type:Organization
Organization Name:AMBONI HOMECARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NASSOR
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:091-938-9567
Mailing Address - Street 1:555 S MANGUM ST STE 3059
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-4688
Mailing Address - Country:US
Mailing Address - Phone:919-389-5674
Mailing Address - Fax:
Practice Address - Street 1:555 S MANGUM ST STE 3059
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-4688
Practice Address - Country:US
Practice Address - Phone:919-389-5674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-31
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care