# ASHTON MEMORIAL INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Gustafson House
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104665587
- **Authorized official:** SUZANNE BRADY (HR DIRECTOR/COMPLIANCE OFFICER)
- **Authorized official phone:** (208) 652-7461

## Contact information

- **Practice address:** 2935 ROLLANDET ST, IDAHO FALLS, ID 83402-4654
- **Practice address phone:** (208) 542-2905
- **Practice address fax:** (208) 522-2427
- **Mailing address:** PO BOX 838, ASHTON, ID 83420-0838
- **Mailing address phone:** (208) 652-7461
- **Mailing address fax:** (208) 652-7595

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 05/23/2024
- **Last updated:** 05/23/2024