Healthcare Provider Details

I. General information

NPI: 1699722876
Provider Name (Legal Business Name): ASHTON COURT HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 11/27/2023
Certification Date: 04/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W COLLEGE ST
LIBERTY MO
64068-1036
US

IV. Provider business mailing address

1200 W COLLEGE ST
LIBERTY MO
64068-1036
US

V. Phone/Fax

Practice location:
  • Phone: 816-781-3020
  • Fax: 816-792-4043
Mailing address:
  • Phone: 816-781-3020
  • Fax: 816-792-4043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number043597
License Number StateMO

VIII. Authorized Official

Name: KENNETH USSERY
Title or Position: VP
Credential:
Phone: 407-571-1550