Healthcare Provider Details

I. General information

NPI: 1720130701
Provider Name (Legal Business Name): ASHBY ROAD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3060 ASHBY RD
SAINT LOUIS MO
63114-1342
US

IV. Provider business mailing address

3060 ASHBY RD
SAINT LOUIS MO
63114-1342
US

V. Phone/Fax

Practice location:
  • Phone: 314-426-0433
  • Fax: 314-426-3580
Mailing address:
  • Phone: 314-426-0433
  • Fax: 314-426-3580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number033566
License Number StateMO

VIII. Authorized Official

Name: GAYLA D BENTLEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 314-426-0433