Basic Information
| Provider Information | |||||||||
| NPI: | 1639148620 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMBERCARE MEDICAL SUPPLY COMPANY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2300 WARRENVILLE RD. | ||||||||
| Address2: | STE 100 | ||||||||
| City: | DOWNERS GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605151765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302963400 | ||||||||
| FaxNumber: | 6304872713 | ||||||||
| Practice Location | |||||||||
| Address1: | 420 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BELEN | ||||||||
| State: | NM | ||||||||
| PostalCode: | 87002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058610060 | ||||||||
| FaxNumber: | 5058615569 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 05/18/2018 | ||||||||
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| AuthorizedOfficialLastName: | KUMARICH | ||||||||
| AuthorizedOfficialFirstName: | DIANE | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP NATIONAL CONTRACTS | ||||||||
| AuthorizedOfficialTelephone: | 6302963530 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ADDUS HEALTHCARE, INC | ||||||||
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| AuthorizedOfficialCredential: | RN, MBA, MS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | B3385 | 05 | NM | MEDICAID |