Provider Demographics
NPI:1497756803
Name:ASHTON MEMORIAL INC
Entity Type:Organization
Organization Name:ASHTON MEMORIAL INC
Other - Org Name:ASHTON LIVING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHON
Authorized Official - Middle Name:
Authorized Official - Last Name:SHULDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-652-7461
Mailing Address - Street 1:PO BOX 838
Mailing Address - Street 2:700 N 2ND ST
Mailing Address - City:ASHTON
Mailing Address - State:ID
Mailing Address - Zip Code:83420-0838
Mailing Address - Country:US
Mailing Address - Phone:208-652-7461
Mailing Address - Fax:208-652-7595
Practice Address - Street 1:700 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ASHTON
Practice Address - State:ID
Practice Address - Zip Code:83420
Practice Address - Country:US
Practice Address - Phone:208-652-7461
Practice Address - Fax:208-652-7595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID26314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID02014OtherBLUE CROSS
ID2283000Medicaid
ID02014OtherBLUE CROSS