Provider Demographics
NPI:1669444154
Name:ELEVEN ASH INC
Entity Type:Organization
Organization Name:ELEVEN ASH INC
Other - Org Name:HEALTH FORCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-275-4747
Mailing Address - Street 1:5276 SUMMERLIN COMMONS WAY
Mailing Address - Street 2:SUITE 702
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907
Mailing Address - Country:US
Mailing Address - Phone:239-275-4747
Mailing Address - Fax:239-275-4210
Practice Address - Street 1:5276 SUMMERLIN COMMONS WAY
Practice Address - Street 2:702
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-2159
Practice Address - Country:US
Practice Address - Phone:239-275-4747
Practice Address - Fax:239-275-4210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHHA20441096251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL671161801Medicaid