1770562688 NPI number — ASHTON HALL INC

Table of content: (NPI 1770562688)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770562688 NPI number — ASHTON HALL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASHTON HALL 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:
ASHTON HALL NURSING AND REHABILITATION CENTER
Provider Other Organization Name Type Code:
3
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:
1770562688
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106 LAKESIDE DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHAMPTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18966
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-355-6288
Provider Business Mailing Address Fax Number:
215-355-8127

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2109 RED LION RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19115-1711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-673-7000
Provider Business Practice Location Address Fax Number:
215-698-4997
Provider Enumeration Date:
01/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SEGAL
Authorized Official First Name:
STANLEY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-355-6288

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  145350 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 314000000X , with the licence number: 0114 02 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 0101946401 . This is a "AMERICHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0006002 000 . This is a "BLUE CROSS KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 116981 0001 . This is a "DMERC A MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000756210 0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1052293 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 13112 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 20134 . This is a "HEALTH PARTNERS SENIOR PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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