Provider Demographics
NPI:1770949356
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 DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:CONRAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-888-2844
Mailing Address - Street 1:3333 S CONGRESS AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-7308
Mailing Address - Country:US
Mailing Address - Phone:954-429-8798
Mailing Address - Fax:954-698-9046
Practice Address - Street 1:3333 S CONGRESS AVE STE 100
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-7300
Practice Address - Country:US
Practice Address - Phone:954-429-8798
Practice Address - Fax:954-698-9046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 253Z00000X
FL299993576251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018501900Medicaid
FL299994431OtherAHCA LICENSE-PREVIOUSLY OPEN SYSTEMS
FL108151900Medicaid
FL003759401Medicaid
FL299993576OtherACHA LICENSE