Provider Demographics
NPI:1932411956
Name:AMBASSADOR REHABILITATION AND HEALTHCARE CENTER, LLC
Entity Type:Organization
Organization Name:AMBASSADOR REHABILITATION AND HEALTHCARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT & SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MEER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-626-0000
Mailing Address - Street 1:2051 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:WADESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28170-3203
Mailing Address - Country:US
Mailing Address - Phone:704-694-4106
Mailing Address - Fax:704-694-6271
Practice Address - Street 1:2051 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:WADESBORO
Practice Address - State:NC
Practice Address - Zip Code:28170-3203
Practice Address - Country:US
Practice Address - Phone:704-694-4106
Practice Address - Fax:704-694-6271
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OLIVE LEAF, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-07
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0090311Z00000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3435392Medicaid
NC3435392Medicaid