Provider Demographics
NPI:1982709457
Name:ASHLEY MANOR, INC.
Entity Type:Organization
Organization Name:ASHLEY MANOR, INC.
Other - Org Name:ASHLEY MANOR CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SCHEULEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-556-6240
Mailing Address - Street 1:1630 RADIO HILL RD
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65233-1957
Mailing Address - Country:US
Mailing Address - Phone:660-882-6584
Mailing Address - Fax:660-882-2267
Practice Address - Street 1:1630 RADIO HILL RD
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:MO
Practice Address - Zip Code:65233-1957
Practice Address - Country:US
Practice Address - Phone:660-882-6584
Practice Address - Fax:660-882-2267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO017160314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO102188604Medicaid
265738Medicare Oscar/Certification