1669529673 NPI number — ASHE SERVICES FOR AGING, INC

Table of content: (NPI 1669529673)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669529673 NPI number — ASHE SERVICES FOR AGING, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASHE SERVICES FOR AGING, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669529673
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
180 CHATTY ROB LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST JEFFERSON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28694-9365
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-246-2461
Provider Business Mailing Address Fax Number:
336-246-5724

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
180 CHATTY ROB LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST JEFFERSON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28694-9365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-246-2461
Provider Business Practice Location Address Fax Number:
336-246-5724
Provider Enumeration Date:
01/04/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CALLOWAY
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
S
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
336-246-2461

Provider Taxonomy Codes

  • Taxonomy code: 251V00000X , with the licence number:  SL001011 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM3000X , with the licence number: CERTIFICATE , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8300174K , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300174 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".