Provider Demographics
NPI:1710562608
Name:THE ASHLEY HOUSE
Entity type:Organization
Organization Name:THE ASHLEY HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-533-9050
Mailing Address - Street 1:33811 9TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6707
Mailing Address - Country:US
Mailing Address - Phone:253-533-9050
Mailing Address - Fax:
Practice Address - Street 1:4118 S COOK ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-4425
Practice Address - Country:US
Practice Address - Phone:253-533-9050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE ASHLEY HOUSE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9030560Medicaid