Provider Demographics
NPI:1003804634
Name:ASBURY ATLANTIC, INC
Entity Type:Organization
Organization Name:ASBURY ATLANTIC, INC
Other - Org Name:FORESTVIEW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-860-7002
Mailing Address - Street 1:2301 EDINBORO RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-3409
Mailing Address - Country:US
Mailing Address - Phone:814-860-7100
Mailing Address - Fax:
Practice Address - Street 1:2301 EDINBORO RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-3409
Practice Address - Country:US
Practice Address - Phone:814-860-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA054102314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1017505810002Medicaid
PA0519OtherBLUE CROSS
PA0519OtherBLUE CROSS