Organization Active NPI

The Ambassador Omaha, Inc.

  • Skilled Nursing Facility
  • Omaha, NE
National Provider Identifier
1184638405
Registry record updated Aug 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
264003 Issued in NE
Legal business name
THE AMBASSADOR OMAHA, INC.
Practice address
1540 N 72ND St
Omaha, NE 68114-1924
Phone
(402) 393-6500
NPI assigned
Jul 29, 2006
Last updated
Aug 17, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Brent B Shanholtz
Title
Chief Financial Officer
Phone
(402) 873-8541

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 264003 NE Primary
Pediatric Skilled Nursing Facility 3140N1450X 264003 NE
Physical Therapist 225100000X 264003 NE
Occupational Therapist 225X00000X 264003 NE
Speech-Language Pathologist 235Z00000X 264003 NE

Addresses

Primary practice location

1540 N 72ND St
Omaha, NE 68114-1924

Mailing address

1540 N 72ND St
Omaha, NE 68114-1924
Phone (402) 873-8541

Other identifiers 3

IdentifierTypeStateIssuer
0517300002OtherNEDME
0517300002OtherIADME
0235010MedicaidSD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100111000588 NE Part A Provider - Skilled Nursing Facility 2567503683 Practice locations: Omaha, NE

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184638405. Details of each certification follow.

Skilled nursing facility certification: CCN 285127

Legal name
THE AMBASSADOR OMAHA INC
Doing business as
AMBASSADOR HEALTH OMAHA
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Jan 29, 1993
Last certification
May 14, 2024
Beds
146
Ownership / control type
Corporation
Multi-facility organization
The Ambassador Group Inc
Organization structure
CorporationProprietary
Enrollment address
1540 N 72ND St
Omaha, NE 68114-1924
Nursing home name
AMBASSADOR HEALTH OF OMAHA
Affiliated entity
AMBASSADOR HEALTH

Care Compare: Nursing home

Medicare Care Compare
Listed as
Ambassador Health of OmahaCCN 285127 · All quality measures
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
4 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Jan 29, 1993
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
14677.9 residents per day on average
Chain
Ambassador Health4 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 23

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
The Ambassador Group Inc Organization, Nebraska City, NE Corporation, Management services company, Chain home office Operational/Managerial Control Feb 9, 1981
Adp of the SNF Feb 9, 1981
Tyler J Juilfs Individual 5% Or Greater Indirect Ownership InterestCeo Dec 30, 2024 5%
Corporate OfficerCeo Jul 1, 2021
Corporate Director Jul 1, 2021
Adp of the SNF Jul 1, 2021
Organization, Omaha, NE LLC, Consulting firm Adp of the SNF May 2, 2025
Organization, Lincoln, NE Management services company Adp of the SNF Apr 17, 2025
Organization, Omaha, NE Medical provider/supplier, Non-profit Adp of the SNF Apr 17, 2025
Sally Juilfs Individual Corporate Officer Jun 5, 1985
Corporate Director Jun 5, 1985
Adp of the SNF Jun 5, 1985
Indirect Ownership Interest Jun 5, 1985 44%
Rebecca Wester Individual Operational/Managerial Control Jan 1, 2024
Adp of the SNF Mar 17, 2025
Ambassador Holding Company Organization, Nebraska City, NE Created for acquisition, Corporation, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jun 5, 1985 100%
Adp of the SNF Jun 5, 1985
Direct Ownership Interest Jun 5, 1985 100%
Organization, Omaha, NE Medical staffing company Adp of the SNF Apr 17, 2025
Organization, Nebraska City, NE Financial institution Adp of the SNF Apr 17, 2025
First National Bank Omaha Organization, Omaha, NE Financial institution, Owned by another organization or individual 5% Or Greater Mortgage Interest Jan 30, 2018 50%
Adp of the SNF Apr 17, 2025
Polly L Stern Individual Operational/Managerial Control Jan 1, 2016
Organization, Kennett Square, PA LLC, Medical provider/supplier Adp of the SNF Apr 17, 2025
Organization, Lincoln, NE LLC, For-profit Adp of the SNF Apr 17, 2025
John C Shehan Individual Operational/Managerial Control Jan 1, 2024
Adp of the SNF Mar 17, 2025
Brent B Shanholtz Individual Operational/Managerial Control Jan 1, 2013
Organization, Omaha, NE Corporation Adp of the SNF Apr 17, 2025
Timothy Juilfs Individual 5% Or Greater Indirect Ownership InterestPresident Jun 5, 1985 44%
Corporate OfficerPresident Jun 5, 1985
Corporate DirectorPresident Jun 5, 1985
Adp of the SNF Jun 5, 1985
Jake J Bleach Individual Operational/Managerial Control Mar 5, 2018
Adp of the SNF Mar 17, 2025
Eli Michael Rhoads Individual Operational/Managerial Control Jan 1, 2024
Adp of the SNF Mar 17, 2025
Organization, Seward, NE LLC, Consulting firm Adp of the SNF Apr 17, 2025
Organization, Omaha, NE Medical provider/supplier Adp of the SNF Apr 17, 2025
Organization, Omaha, NE Medical provider/supplier, Non-profit Adp of the SNF Apr 17, 2025

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534464000000",
    "number": "1184638405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1540 N 72ND ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681141924",
            "telephone_number": "402-873-8541",
            "fax_number": "402-873-7244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1540 N 72ND ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681141924",
            "telephone_number": "402-393-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE AMBASSADOR OMAHA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-29",
        "last_updated": "2018-08-17",
        "status": "A",
        "authorized_official_last_name": "SHANHOLTZ",
        "authorized_official_first_name": "BRENT",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "402-873-8541"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NE",
            "license": "264003",
            "primary": true
        },
        {
            "code": "3140N1450X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility, Nursing Care, Pediatric",
            "state": "NE",
            "license": "264003",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NE",
            "license": "264003",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NE",
            "license": "264003",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NE",
            "license": "264003",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME",
            "identifier": "0517300002",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME",
            "identifier": "0517300002",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0235010",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.