Healthcare Provider Details

I. General information

NPI: 1275681553
Provider Name (Legal Business Name): ASANTE COMMUNITY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SW RAMSEY SUITE 101
GRANTS PASS OR
97527-5554
US

IV. Provider business mailing address

500 SW RAMSEY AVENUE
GRANTS PASS OR
97527-5554
US

V. Phone/Fax

Practice location:
  • Phone: 541-507-2680
  • Fax:
Mailing address:
  • Phone: 541-507-2680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier298523
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: GREG G WOJTAL
Title or Position: CAFO
Credential:
Phone: 541-789-4549