Provider Demographics
NPI:1952831281
Name:ASHFORD AT MT. WASHINGTON, LLC
Entity Type:Organization
Organization Name:ASHFORD AT MT. WASHINGTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL BOM
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-753-3961
Mailing Address - Street 1:160 W MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-1189
Mailing Address - Country:US
Mailing Address - Phone:614-863-4640
Mailing Address - Fax:
Practice Address - Street 1:1131 DELIQUIA DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-1399
Practice Address - Country:US
Practice Address - Phone:513-231-0008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-19
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0221506Medicaid