Organization
AMBROSE HEALTHCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TRAVIS COLLETTE (VP OF BUSINESS DEVELOPMENT)
(208) 360-7668
Entity
Organization
Contact information
Practice address
920 HERITAGE PARK BLVD STE 120, LAYTON, UT 84041-5609
(801) 335-6455
Mailing address
920 HERITAGE PARK BLVD STE 120, LAYTON, UT 84041-5609
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
2018-HHA-UT000840
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2018-HHA-UT000840
STATE LICENSE NUMBER
UT
Enumeration date
03/19/2018
Last updated
03/19/2018
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