Active NPI
The Ambassador Omaha, Inc.
- Skilled Nursing Facility
- Omaha, NE
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 264003
- 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, 2018
- Organization subpart
- No
NPPES NPI Registry
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) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0517300002 | Other | NE | DME |
| 0517300002 | Other | IA | DME |
| 0235010 | Medicaid | SD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NE
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
- Corporation
- 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 Omaha
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Jan 29, 1993
- Medicare certification status
- Active
- Certified beds
- 146
- Chain
- Ambassador Health
National Provider Directory
National Provider DirectoryOwnership & 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.
| Name | Role | Since | Share |
|---|---|---|---|
| The Ambassador Group Inc | Operational/Managerial Control | Feb 9, 1981 | |
| Adp of the SNF | Feb 9, 1981 | ||
| Tyler J Juilfs | 5% Or Greater Indirect Ownership Interest | Dec 30, 2024 | 5% |
| Corporate Officer | Jul 1, 2021 | ||
| Corporate Director | Jul 1, 2021 | ||
| Adp of the SNF | Jul 1, 2021 | ||
| Adp of the SNF | May 2, 2025 | ||
| Adp of the SNF | Apr 17, 2025 | ||
| Adp of the SNF | Apr 17, 2025 | ||
| Sally Juilfs | 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 | Operational/Managerial Control | Jan 1, 2024 | |
| Adp of the SNF | Mar 17, 2025 | ||
| Ambassador Holding Company | 5% Or Greater Direct Ownership Interest | Jun 5, 1985 | 100% |
| Adp of the SNF | Jun 5, 1985 | ||
| Direct Ownership Interest | Jun 5, 1985 | 100% | |
| Adp of the SNF | Apr 17, 2025 | ||
| Adp of the SNF | Apr 17, 2025 | ||
| First National Bank Omaha | 5% Or Greater Mortgage Interest | Jan 30, 2018 | 50% |
| Adp of the SNF | Apr 17, 2025 | ||
| Polly L Stern | Operational/Managerial Control | Jan 1, 2016 | |
| Adp of the SNF | Apr 17, 2025 | ||
| Adp of the SNF | Apr 17, 2025 | ||
| John C Shehan | Operational/Managerial Control | Jan 1, 2024 | |
| Adp of the SNF | Mar 17, 2025 | ||
| Brent B Shanholtz | Operational/Managerial Control | Jan 1, 2013 | |
| Adp of the SNF | Apr 17, 2025 | ||
| Timothy Juilfs | 5% Or Greater Indirect Ownership Interest | Jun 5, 1985 | 44% |
| Corporate Officer | Jun 5, 1985 | ||
| Corporate Director | Jun 5, 1985 | ||
| Adp of the SNF | Jun 5, 1985 | ||
| Jake J Bleach | Operational/Managerial Control | Mar 5, 2018 | |
| Adp of the SNF | Mar 17, 2025 | ||
| Eli Michael Rhoads | Operational/Managerial Control | Jan 1, 2024 | |
| Adp of the SNF | Mar 17, 2025 | ||
| Adp of the SNF | Apr 17, 2025 | ||
| Adp of the SNF | Apr 17, 2025 | ||
| 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.
-
- Pediatric Pulmonology Physician
- Omaha, NE
- NPI 1194112029
Adp of the SNF, Operational/Managerial Control
-
- Pulmonary Disease Physician
- Omaha, NE
- NPI 1902800287
Adp of the SNF, Operational/Managerial Control
-
- Family Medicine Physician
- Omaha, NE
- NPI 1790767713
Adp of the SNF, Operational/Managerial Control
Facilities with the same owner 3
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
- Skilled Nursing Facility
- Lincoln, NE
- NPI 1811901259
Ambassador Holding Company, The Ambassador Group Inc
-
- Skilled Nursing Facility
- Nebraska City, NE
- NPI 1992771299
The Ambassador Group Inc
-
dba The Ambassador Sidney
- Skilled Nursing Facility
- Sidney, IA
- NPI 1902811276
Ambassador Holding Company, The Ambassador Group Inc
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.
-
- Pediatric Pulmonology Physician
- Omaha, NE
- NPI 1194112029
-
- Pulmonary Disease Physician
- Omaha, NE
- NPI 1902800287
-
- Family Medicine Physician
- Omaha, NE
- NPI 1790767713
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.