Provider Demographics
NPI:1962976829
Name:AMBASSADOR FOR HOME,LLC
Entity type:Organization
Organization Name:AMBASSADOR FOR HOME,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:RANSOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-662-0697
Mailing Address - Street 1:2939 W GERMANTOWN PIKE STE A
Mailing Address - Street 2:
Mailing Address - City:EAGLEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19403-1062
Mailing Address - Country:US
Mailing Address - Phone:484-685-5100
Mailing Address - Fax:484-685-5107
Practice Address - Street 1:2939 W GERMANTOWN PIKE STE A
Practice Address - Street 2:
Practice Address - City:EAGLEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19403-1062
Practice Address - Country:US
Practice Address - Phone:484-685-5100
Practice Address - Fax:484-685-5107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-14
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103747226-0001Medicaid