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NPI Code Detail

MEDICARE: ASHLEY LTC INC

MEDICARE: ASHLEY LTC INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility01-0000064CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487641049
Entity Type Code : Organization
Provider Name (Legal Business Name) : ASHLEY LTC INC
Provider Business Mailing Address
First Line : 446 ARROWOOD DR
Second Line :
City : SANTA ROSA
State : CA
Zip : 95407-7503
Country : US
Telephone Number : 707-528-2100
Fax Number : 707-568-1209
Provider Business Practice Location Address
First Line : 446 ARROWOOD DR
Second Line :
City : SANTA ROSA
State : CA
Zip : 95407-7503
Country : US
Telephone Number : 707-528-2100
Fax Number : 707-568-1209
Authorized Official
Title or Position : ADMINISTRATOR
Name : FREDERICK C BENSON
Credential : JD
Telephone Number : 707-528-2100
Provider Enumeration Date : 09/29/2005
Last Update Date : 12/26/2011

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Directions to “ASHLEY LTC INC ” Practice Location

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