Organization
AMBITIOUS PROVIDER SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRYMI DANIELLE MATHIS (PROGRAM MANAGER)
(469) 735-3395
Entity
Organization
Contact information
Practice address
8035 E R L THORNTON FWY, 468, DALLAS, TX 75228-7018
(469) 735-3395
(469) 941-4158
Mailing address
8035 E. RLT. FRWY., 468, DALLAS, TX 75228-1020
(469) 735-3395
(469) 941-4158
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
Other
Enumeration date
01/06/2017
Last updated
01/06/2017
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