Provider Demographics
NPI:1659368884
Name:KINGSTON OF ASHLAND, LLC
Entity Type:Organization
Organization Name:KINGSTON OF ASHLAND, LLC
Other - Org Name:KINGSTON OF ASHLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:NIRSCHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-247-2824
Mailing Address - Street 1:PO BOX 2165
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43603-2165
Mailing Address - Country:US
Mailing Address - Phone:419-247-2880
Mailing Address - Fax:419-247-2872
Practice Address - Street 1:20 AMBERWOOD PKWY
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-9765
Practice Address - Country:US
Practice Address - Phone:419-289-3859
Practice Address - Fax:419-289-6357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1813N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2611230Medicaid
OH000000156467OtherANTHEM
365646Medicare ID - Type Unspecified
OH000000156467OtherANTHEM