Provider Demographics
NPI:1639519986
Name:ASCC, LLC
Entity type:Organization
Organization Name:ASCC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-548-8046
Mailing Address - Street 1:28202 CABOT RD
Mailing Address - Street 2:412
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-1222
Mailing Address - Country:US
Mailing Address - Phone:949-347-7100
Mailing Address - Fax:949-347-7800
Practice Address - Street 1:5320 CARRINGTON CIR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-3515
Practice Address - Country:US
Practice Address - Phone:209-473-3004
Practice Address - Fax:209-473-3329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA555496Medicare Oscar/Certification