Organization
AMBASSADOR SOARS SUPPORTIVE LIVING AND TRANSPORTATION SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DWAIMEON M JORDAN (PRESIDENT)
(727) 557-5995
Entity
Organization
Contact information
Practice address
5006 TROUBLE CREEK RD STE 101, NEW PORT RICHEY, FL 34652-4937
(727) 557-5995
Mailing address
5317 ANHINGA TRL, NEW PORT RICHEY, FL 34653-7032
(727) 557-5995
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
372600000X
Adult Companion
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104733300
—
FL
Enumeration date
09/29/2021
Last updated
09/29/2021
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