MEDICARE: AMERISTAR ASSISTED LIVING, 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
1	310400000X	Assisted Living Facility	16AL1059-B	MD

General Provider Information

NPI Number	:	1518402270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERISTAR ASSISTED LIVING, INC.

Provider Business Mailing Address
First Line	:	6604 ADRIAN ST
Second Line	:
City	:	NEW CARROLLTON
State	:	MD
Zip	:	20784-3610
Country	:	US
Telephone Number	:	301-474-7840
Fax Number	:

Provider Business Practice Location Address
First Line	:	6604 ADRIAN ST
Second Line	:
City	:	NEW CARROLLTON
State	:	MD
Zip	:	20784-3610
Country	:	US
Telephone Number	:	301-474-7840
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. WILFRED KANDIE CHEMWEI KANDIE
Credential	:
Telephone Number	:	301-474-7840

Provider Enumeration Date	:	01/04/2017
Last Update Date	:	01/04/2017

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