Healthcare Provider Details

I. General information

NPI: 1497756803
Provider Name (Legal Business Name): ASHTON MEMORIAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N 2ND ST
ASHTON ID
83420
US

IV. Provider business mailing address

PO BOX 838 700 N 2ND ST
ASHTON ID
83420-0838
US

V. Phone/Fax

Practice location:
  • Phone: 208-652-7461
  • Fax: 208-652-7595
Mailing address:
  • Phone: 208-652-7461
  • Fax: 208-652-7595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number26
License Number StateID

VIII. Authorized Official

Name: SUZANNE NIELSEN
Title or Position: HR DIRECTOR
Credential:
Phone: 208-652-7461