Healthcare Provider Details

I. General information

NPI: 1639519986
Provider Name (Legal Business Name): ASCC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5320 CARRINGTON CIR
STOCKTON CA
95210-3515
US

IV. Provider business mailing address

28202 CABOT RD 412
LAGUNA NIGUEL CA
92677-1222
US

V. Phone/Fax

Practice location:
  • Phone: 209-473-3004
  • Fax: 209-473-3329
Mailing address:
  • Phone: 949-347-7100
  • Fax: 949-347-7800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY BRADSHAW
Title or Position: MANAGER
Credential:
Phone: 714-548-8046