Amboni Healthsource LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

AMBONI HEALTHSOURCE LLC

Practice address

25630 Farrier Dr
Richmond, TX 77406-1468

Phone

(214) 830-9906

NPI assigned

May 27, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Prosper Kiswaga

Title

MD

Phone

(214) 830-9906

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1590537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718236800000",
    "number": "1073136800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25630 FARRIER DR",
            "city": "RICHMOND",
            "state": "TX",
            "postal_code": "774061468",
            "telephone_number": "214-830-9906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25630 FARRIER DR",
            "city": "RICHMOND",
            "state": "TX",
            "postal_code": "774061468",
            "telephone_number": "214-830-9906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMBONI HEALTHSOURCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-27",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "status": "A",
        "authorized_official_last_name": "KISWAGA",
        "authorized_official_first_name": "PROSPER",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "214-830-9906",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Richmond, TX
• Providers in Richmond, TX by specialty
• Community/Behavioral Health Agency in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.