Provider Demographics
NPI:1497292858
Name:ASBURY ATLANTIC, INC
Entity Type:Organization
Organization Name:ASBURY ATLANTIC, INC
Other - Org Name:ASBURY SOLOMON'S ISLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRUS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MAGS
Authorized Official - Phone:410-394-3030
Mailing Address - Street 1:11100 ASBURY CIR
Mailing Address - Street 2:
Mailing Address - City:SOLOMONS
Mailing Address - State:MD
Mailing Address - Zip Code:20688-3004
Mailing Address - Country:US
Mailing Address - Phone:410-394-3000
Mailing Address - Fax:410-394-3008
Practice Address - Street 1:11100 ASBURY CIR
Practice Address - Street 2:
Practice Address - City:SOLOMONS
Practice Address - State:MD
Practice Address - Zip Code:20688-3004
Practice Address - Country:US
Practice Address - Phone:410-394-3000
Practice Address - Fax:410-394-3008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-24
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD300175000Medicaid
MD300175000Medicaid