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Organization

AMBASSADOR HEALTHCARE, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. K. DOUGLAS COOK (MEMBER)
(317) 577-4150
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
050004561
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000315404
BC/BS PROVIDER NUMBER
IN
Enumeration date
09/12/2005
Last updated
12/01/2009
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