# THE AMBASSADOR OMAHA, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184638405
- **Authorized official:** BRENT B SHANHOLTZ (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (402) 873-8541

## Contact information

- **Practice address:** 1540 N 72ND ST, OMAHA, NE 68114-1924
- **Practice address phone:** (402) 393-6500
- **Mailing address:** 1540 N 72ND ST, OMAHA, NE 68114-1924
- **Mailing address phone:** (402) 873-8541
- **Mailing address fax:** (402) 873-7244

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 264003 | NE | — |
| 225X00000X | Occupational Therapist | 264003 | NE | — |
| 235Z00000X | Speech-Language Pathologist | 264003 | NE | — |
| 314000000X | Skilled Nursing Facility | 264003 | NE | Yes |
| 3140N1450X | Pediatric Skilled Nursing Facility | 264003 | NE | — |

## Other

- **Enumeration date:** 07/29/2006
- **Last updated:** 08/17/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0235010 | — | SD |
| 01 | — | 0517300002 | DME | IA |
| 01 | — | 0517300002 | DME | NE |