# AMBASSADOR HEALTHCARE, LLC

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

## Provider details

- **NPI number:** 1356336861
- **Authorized official:** MR. K. DOUGLAS COOK (MEMBER)
- **Authorized official phone:** (317) 577-4150

## Contact information

- **Practice address:** 705 E MAIN ST, CENTERVILLE, IN 47330-9676
- **Practice address phone:** (765) 855-3424
- **Practice address fax:** (765) 855-1087
- **Mailing address:** 12953 PUBLISHERS DR, SUITE 200, FISHERS, IN 46038-8811
- **Mailing address phone:** (317) 577-2827
- **Mailing address fax:** (317) 577-5933

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 050004561 | IN | Yes |

## Other

- **Enumeration date:** 09/12/2005
- **Last updated:** 12/01/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000315404 | BC/BS PROVIDER NUMBER | IN |