Provider Demographics
NPI:1841304342
Name:ASHLEY MEDICAL CENTER
Entity type:Organization
Organization Name:ASHLEY MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LEPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-288-3433
Mailing Address - Street 1:PO BOX 450
Mailing Address - Street 2:612 CENTER AVENUE NORTH
Mailing Address - City:ASHLEY
Mailing Address - State:ND
Mailing Address - Zip Code:58413-0450
Mailing Address - Country:US
Mailing Address - Phone:701-288-3433
Mailing Address - Fax:701-288-3938
Practice Address - Street 1:612 CENTER AVE N
Practice Address - Street 2:
Practice Address - City:ASHLEY
Practice Address - State:ND
Practice Address - Zip Code:58413-7013
Practice Address - Country:US
Practice Address - Phone:701-288-3433
Practice Address - Fax:701-288-3938
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASHLEY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-19
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1001A314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND3319OtherSKILLED NURSING FACILITY
ND30188Medicaid
ND3319OtherSKILLED NURSING FACILITY