Organization · NPI-2

Ashton Memorial INC

Residential Treatment Facility, Emotionally Disturbed Children · Idaho Falls, ID

NPI number1104665587
StatusActive
Last updated in NPPESMay 23, 2024

Details

NPI
1104665587
Entity type
Organization (NPI-2)
Legal business name
Ashton Memorial INC
Organization subpart
No
Enumeration date
May 23, 2024
Certification date
May 23, 2024
Last updated
May 23, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
322D00000X Residential Treatment Facility, Emotionally Disturbed Children––Yes

Other names

  • Gustafson House (Doing Business As)

Practice location

2935 Rollandet St
Idaho Falls, ID 83402-4654

Phone 208-542-2905 · Fax 208-522-2427

Mailing address

Po Box 838
Ashton, ID 83420-0838

Phone 208-652-7461 · Fax 208-652-7595

Authorized official

Suzanne Brady
Hr Director/Compliance Officer
2086527461

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