Provider Demographics
NPI:1629432075
Name:ASHLI HEALTHCARE, INC.
Entity Type:Organization
Organization Name:ASHLI HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HME DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HERIBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:HMDR
Authorized Official - Phone:661-979-4619
Mailing Address - Street 1:2201 ZEUS CT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-6867
Mailing Address - Country:US
Mailing Address - Phone:888-831-7977
Mailing Address - Fax:888-831-0909
Practice Address - Street 1:1860 K ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-4818
Practice Address - Country:US
Practice Address - Phone:209-722-7228
Practice Address - Fax:209-722-7263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78596332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========Medicaid