Provider Demographics
NPI:1649285578
Name:THE AMBASSADOR REHAB & WELLNESS CENTER, INC.
Entity type:Organization
Organization Name:THE AMBASSADOR REHAB & WELLNESS CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT - OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:JUILFS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-873-7791
Mailing Address - Street 1:1240 N 19TH ST
Mailing Address - Street 2:STE # 2
Mailing Address - City:NEBRASKA CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68410-1119
Mailing Address - Country:US
Mailing Address - Phone:402-873-4838
Mailing Address - Fax:402-873-4117
Practice Address - Street 1:1240 N 19TH ST
Practice Address - Street 2:STE # 2
Practice Address - City:NEBRASKA CITY
Practice Address - State:NE
Practice Address - Zip Code:68410-1119
Practice Address - Country:US
Practice Address - Phone:402-873-4838
Practice Address - Fax:402-873-4117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0513721Medicaid
NE=========-32Medicaid
NE=========OtherMIDLANDS CHOICE
IA0513721Medicaid
NE=========-68Medicaid
NE=========OtherMETHODIST HEALTH SYSTEM