Provider Demographics
NPI:1225496706
Name:AMBASSADOR OPERATIONS LLC
Entity Type:Organization
Organization Name:AMBASSADOR OPERATIONS LLC
Other - Org Name:THE AMBASSADOR SKILLED NURSING AND THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-943-1144
Mailing Address - Street 1:1340 E 61ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-0605
Mailing Address - Country:US
Mailing Address - Phone:918-743-8978
Mailing Address - Fax:
Practice Address - Street 1:4350 WILL ROGERS PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73108-1826
Practice Address - Country:US
Practice Address - Phone:405-943-1144
Practice Address - Fax:406-639-2742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-29
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility