MEDICARE: ASGW ,LLC

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	310400000X	Assisted Living Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	074468514	OTHER		DUNS

General Provider Information

NPI Number	:	1366177594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASGW ,LLC

Provider Business Mailing Address
First Line	:	36688 BRIARCLIFF RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48312-2712
Country	:	US
Telephone Number	:	248-812-9410
Fax Number	:

Provider Business Practice Location Address
First Line	:	36688 BRIARCLIFF RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48312-2712
Country	:	US
Telephone Number	:	248-812-9410
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	LEO MARINO
Credential	:
Telephone Number	:	248-812-9410

Provider Enumeration Date	:	07/21/2022
Last Update Date	:	07/21/2022

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Directions to “ASGW ,LLC ” Practice Location

Language	Start Address	Practice Location

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