Healthcare Provider Details

I. General information

NPI: 1932725967
Provider Name (Legal Business Name): ASHLAND ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2020
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 SKYLARK PL
ASHLAND OR
97520-9640
US

IV. Provider business mailing address

1701 S SUTRO TER
CARSON CITY NV
89706-0364
US

V. Phone/Fax

Practice location:
  • Phone: 541-552-1713
  • Fax: 541-552-1058
Mailing address:
  • Phone: 775-468-6114
  • Fax: 775-562-4757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: DARRYL FISHER
Title or Position: MANAGER
Credential:
Phone: 775-468-6114