Provider Demographics
NPI:1306697826
Name:AMBAH CARE COMMUNITY SERVICE LLC
Entity type:Organization
Organization Name:AMBAH CARE COMMUNITY SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHERNOR
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-649-4550
Mailing Address - Street 1:1393 GREENCROFT RD
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-1781
Mailing Address - Country:US
Mailing Address - Phone:614-649-4550
Mailing Address - Fax:614-413-4727
Practice Address - Street 1:1393 GREENCROFT RD
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-1781
Practice Address - Country:US
Practice Address - Phone:614-649-4550
Practice Address - Fax:614-413-4727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health