Basic Information
| Provider Information | |||||||||
| NPI: | 1285292102 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASMS, 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: | 1330 17TH ST | ||||||||
| Address2: | |||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904041902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108295411 | ||||||||
| FaxNumber: | 3104537704 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2019 | ||||||||
| LastUpdateDate: | 06/05/2019 | ||||||||
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| AuthorizedOfficialLastName: | BRADSHAW | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9493477100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 05515 | 05 | CA | MEDICAID |