Provider Demographics
NPI:1932725967
Name:ASHLAND ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:ASHLAND ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-468-6114
Mailing Address - Street 1:1701 S SUTRO TER
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-0364
Mailing Address - Country:US
Mailing Address - Phone:775-468-6114
Mailing Address - Fax:775-562-4757
Practice Address - Street 1:900 SKYLARK PL
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-9640
Practice Address - Country:US
Practice Address - Phone:541-552-1713
Practice Address - Fax:541-552-1058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR525976Medicaid
OR525734Medicaid