Provider Demographics
NPI:1518402270
Name:AMERISTAR ASSISTED LIVING, INC.
Entity Type:Organization
Organization Name:AMERISTAR ASSISTED LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILFRED KANDIE
Authorized Official - Middle Name:CHEMWEI
Authorized Official - Last Name:KANDIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-474-7840
Mailing Address - Street 1:6604 ADRIAN ST
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3610
Mailing Address - Country:US
Mailing Address - Phone:301-474-7840
Mailing Address - Fax:
Practice Address - Street 1:6604 ADRIAN ST
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3610
Practice Address - Country:US
Practice Address - Phone:301-474-7840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16AL1059-B310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility