MEDICARE: AMBASSADOR HEALTH AT HOME, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1316474273
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMBASSADOR HEALTH AT HOME, INC.

Provider Business Mailing Address
First Line	:	PO BOX 640
Second Line	:
City	:	NEBRASKA CITY
State	:	NE
Zip	:	68410-1119
Country	:	US
Telephone Number	:	402-873-7791
Fax Number	:	402-873-7244

Provider Business Practice Location Address
First Line	:	1240 N 19TH ST
Second Line	:
City	:	NEBRASKA CITY
State	:	NE
Zip	:	68410-1119
Country	:	US
Telephone Number	:	402-873-7791
Fax Number	:	402-873-7244

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TIMOTHY J JUILFS
Credential	:
Telephone Number	:	402-873-7791

Provider Enumeration Date	:	05/22/2017
Last Update Date	:	07/21/2022

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