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General NPI Number Information
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NPI Number | 1508365438
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Entity Type | Organization
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Legal Business Name | ASHLEY MANOR, LLC
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Dates
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Enumeration Date | 02/06/2018
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Last Update Date | 03/01/2022
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Provider Practice Location Address
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Address Line | 1102 4TH ST
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City | FORT LUPTON
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State | CO
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Zip | 80621-1738
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Country | US
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Telephone | 303-857-0116
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1176
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City | MERIDIAN
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State | ID
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Zip | 83680-1176
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED PERSON
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Name | MR. MARK A ELLISON
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Credential |
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Telephone | 208-376-7298
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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