Healthcare Provider Details

I. General information

NPI: 1043207301
Provider Name (Legal Business Name): ASBURY PARK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 02/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SW 14TH ST
NEWTON KS
67114-4701
US

IV. Provider business mailing address

200 SW 14TH ST
NEWTON KS
67114-4701
US

V. Phone/Fax

Practice location:
  • Phone: 316-283-4770
  • Fax: 316-283-4799
Mailing address:
  • Phone: 316-283-4770
  • Fax: 316-283-4799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1041006201
Identifier TypeMEDICAID
Identifier StateKS
Identifier Issuer

VIII. Authorized Official

Name: MR. THOMAS R. WILLIAMS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 316-283-4770