Healthcare Provider Details

I. General information

NPI: 1003804634
Provider Name (Legal Business Name): ASBURY ATLANTIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 EDINBORO RD
ERIE PA
16509-3409
US

IV. Provider business mailing address

2301 EDINBORO RD
ERIE PA
16509-3409
US

V. Phone/Fax

Practice location:
  • Phone: 814-860-7100
  • Fax:
Mailing address:
  • Phone: 814-860-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number054102
License Number StatePA

VIII. Authorized Official

Name: JAMES SCHNEIDER
Title or Position: ADMINISTRATOR
Credential:
Phone: 814-860-7002