1801191978 NPI number — ASHTON PLACE HEALTH AND REHAB, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801191978 NPI number — ASHTON PLACE HEALTH AND REHAB, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASHTON PLACE HEALTH AND REHAB, LLC
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:
1801191978
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 ROGERS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT SMITH
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72901-1903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-783-4672
Provider Business Mailing Address Fax Number:
479-783-2217

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
318 STROZIER LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARLING
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72923-2323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-452-8181
Provider Business Practice Location Address Fax Number:
479-242-1982
Provider Enumeration Date:
01/20/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MORTON
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
479-783-4672

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 185765311 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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