Provider Demographics
NPI:1285738401
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 AVE NO
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4001A251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND54852Medicaid
ND737OtherHOME HEALTH
ND357008Medicare ID - Type UnspecifiedHOME HEALTH