Basic Information
| Provider Information | |||||||||
| NPI: | 1245865682 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASBW, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 28202 CABOT RD STE 412 | ||||||||
| Address2: | |||||||||
| City: | LAGUNA NIGUEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926771271 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9493477100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1623 ARIZONA AVE | ||||||||
| Address2: | |||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904041209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108294565 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2020 | ||||||||
| LastUpdateDate: | 03/05/2020 | ||||||||
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| AuthorizedOfficialLastName: | KIRKWOOD | ||||||||
| AuthorizedOfficialFirstName: | JARED | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | GENERAL COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 9493477100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.