Provider Demographics
NPI:1952679045
Name:KS AMBASSADORS HOME CARE SVC, INC
Entity type:Organization
Organization Name:KS AMBASSADORS HOME CARE SVC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SINCLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-426-0172
Mailing Address - Street 1:PO BOX 27177
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-5036
Mailing Address - Country:US
Mailing Address - Phone:910-426-0172
Mailing Address - Fax:910-426-0173
Practice Address - Street 1:2622 DUMBARTON RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-2716
Practice Address - Country:US
Practice Address - Phone:910-426-0172
Practice Address - Fax:910-426-0173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care