Provider Demographics
NPI:1720130701
Name:ASHBY ROAD INC.
Entity Type:Organization
Organization Name:ASHBY ROAD INC.
Other - Org Name:BENTLEYS EXTENDED CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GAYLA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BENTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-426-0433
Mailing Address - Street 1:3060 ASHBY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63114-1342
Mailing Address - Country:US
Mailing Address - Phone:314-426-0433
Mailing Address - Fax:314-426-3580
Practice Address - Street 1:3060 ASHBY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63114-1342
Practice Address - Country:US
Practice Address - Phone:314-426-0433
Practice Address - Fax:314-426-3580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO033566314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO104692504Medicaid
MO265732Medicare Oscar/Certification