Provider Demographics
NPI:1104665587
Name:ASHTON MEMORIAL INC
Entity type:Organization
Organization Name:ASHTON MEMORIAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR DIRECTOR/COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-652-7461
Mailing Address - Street 1:PO BOX 838
Mailing Address - Street 2:
Mailing Address - City:ASHTON
Mailing Address - State:ID
Mailing Address - Zip Code:83420-0838
Mailing Address - Country:US
Mailing Address - Phone:208-652-7461
Mailing Address - Fax:208-652-7595
Practice Address - Street 1:2935 ROLLANDET ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-4654
Practice Address - Country:US
Practice Address - Phone:208-542-2905
Practice Address - Fax:208-522-2427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children