Basic Information
| Provider Information | |||||||||
| NPI: | 1376571711 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASHTON PLACE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1009 | ||||||||
| Address2: | |||||||||
| City: | GORE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744351009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184892755 | ||||||||
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| Practice Location | |||||||||
| Address1: | 318 STROZIER LANE | ||||||||
| Address2: | |||||||||
| City: | BARLING | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729231436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794528181 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MONTGOMERY | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | BRADFORD | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9184892755 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 313M00000X | 804 | AR | X | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility | 314000000X | X | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.