MEDICARE: ASHTON HOMES, LLC

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
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1508364811
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASHTON HOMES, LLC

Provider Business Mailing Address
First Line	:	3300 COUNTY ROAD 10 STE 314
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55429-3066
Country	:	US
Telephone Number	:	763-321-0351
Fax Number	:

Provider Business Practice Location Address
First Line	:	4913 WINCHESTER LN
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55429-1637
Country	:	US
Telephone Number	:	763-354-0850
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	SEKOU A. M. DUKULY
Credential	:
Telephone Number	:	763-321-0351

Provider Enumeration Date	:	02/01/2018
Last Update Date	:	03/17/2018

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