Provider Demographics
NPI:1043207301
Name:ASBURY PARK, INC.
Entity Type:Organization
Organization Name:ASBURY PARK, INC.
Other - Org Name:FRIENDLY ACRES, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-283-4770
Mailing Address - Street 1:200 SW 14TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-4701
Mailing Address - Country:US
Mailing Address - Phone:316-283-4770
Mailing Address - Fax:316-283-4799
Practice Address - Street 1:200 SW 14TH ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-4701
Practice Address - Country:US
Practice Address - Phone:316-283-4770
Practice Address - Fax:316-283-4799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1041006201Medicaid
KS1041006201Medicaid