Healthcare Provider Details

I. General information

NPI: 1538133053
Provider Name (Legal Business Name): ASBURY ATLANTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 01/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 WILSON LN
MECHANICSBURG PA
17055-6663
US

IV. Provider business mailing address

5225 WILSON LN
MECHANICSBURG PA
17055-6663
US

V. Phone/Fax

Practice location:
  • Phone: 717-591-8001
  • Fax: 717-766-0870
Mailing address:
  • Phone: 717-591-8001
  • Fax: 717-766-0870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number024402
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier1017505810003
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MR. BRIAN GRUNDUSKY
Title or Position: EXECUTIVE DIRECTOR
Credential: NHA
Phone: 717-591-8027