Provider Demographics
NPI:1487643870
Name:ASBURY ATLANTIC, INC.
Entity Type:Organization
Organization Name:ASBURY ATLANTIC, INC.
Other - Org Name:EPWORTH MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH INFORMATION TECHNICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:MYRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ISENBERG
Authorized Official - Suffix:I
Authorized Official - Credentials:RHIT
Authorized Official - Phone:814-684-0320
Mailing Address - Street 1:951 WASHINGTON AVE
Mailing Address - Street 2:925 S. LINCOLN AVENUE
Mailing Address - City:TYRONE
Mailing Address - State:PA
Mailing Address - Zip Code:16686-1426
Mailing Address - Country:US
Mailing Address - Phone:814-684-0320
Mailing Address - Fax:814-684-0902
Practice Address - Street 1:951 WASHINGTON AVE
Practice Address - Street 2:925 S. LINCOLN AVENUE
Practice Address - City:TYRONE
Practice Address - State:PA
Practice Address - Zip Code:16686-1426
Practice Address - Country:US
Practice Address - Phone:814-684-0320
Practice Address - Fax:814-684-0902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA3144703104A0630X
PA050802314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1017505810001Medicaid
PA39-5393Medicare ID - Type Unspecified