Provider Demographics
NPI:1447376066
Name:AMBERCARE HOME HEALTH CARE CORPORATION
Entity type:Organization
Organization Name:AMBERCARE HOME HEALTH CARE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & COO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:BICKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-535-8200
Mailing Address - Street 1:6303 COWBOYS WAY STE 600
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-0329
Mailing Address - Country:US
Mailing Address - Phone:575-388-0222
Mailing Address - Fax:575-388-1493
Practice Address - Street 1:1290 E 32ND ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7229
Practice Address - Country:US
Practice Address - Phone:575-342-9001
Practice Address - Fax:575-388-1493
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMBERCARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-22
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6469251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM327061Medicare ID - Type Unspecified
NMN1714Medicaid