Provider Demographics
NPI:1528316346
Name:ASHBY LIVING CENTER INC.
Entity type:Organization
Organization Name:ASHBY LIVING CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-790-6427
Mailing Address - Street 1:520 28TH ST N
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-2441
Mailing Address - Country:US
Mailing Address - Phone:218-359-9999
Mailing Address - Fax:
Practice Address - Street 1:112 IVERSON AVENUE
Practice Address - Street 2:
Practice Address - City:ASHBY
Practice Address - State:MN
Practice Address - Zip Code:56309
Practice Address - Country:US
Practice Address - Phone:218-747-2995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN354468310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2373560OtherHFID 26942