Provider Demographics
NPI:1861633976
Name:ASF OF EDMOND LLC
Entity Type:Organization
Organization Name:ASF OF EDMOND LLC
Other - Org Name:BRADFORD VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:COATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-564-8002
Mailing Address - Street 1:205 POWELL PL
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7522
Mailing Address - Country:US
Mailing Address - Phone:615-369-0620
Mailing Address - Fax:615-369-0622
Practice Address - Street 1:250 ENZ DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-4436
Practice Address - Country:US
Practice Address - Phone:405-341-0810
Practice Address - Fax:405-341-0976
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN SENIORS FOUNDATION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy