Basic Information
| Provider Information | |||||||||
| NPI: | 1801873989 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ASHLEY, INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | ASHLEY ADDICTION TREATMENT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 800 TYDINGS LN | ||||||||
| Address2: | |||||||||
| City: | HAVRE DE GRACE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210782102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102732213 | ||||||||
| FaxNumber: | 4103442416 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 TYDINGS LN | ||||||||
| Address2: | |||||||||
| City: | HAVRE DE GRACE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210782132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102736600 | ||||||||
| FaxNumber: | 4102725617 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2005 | ||||||||
| LastUpdateDate: | 04/06/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BURGESS | ||||||||
| AuthorizedOfficialFirstName: | JIM | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 4102732319 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | 13906 | MD | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
ID Information
| ID | Type | State | Issuer | Description | 003653 | 01 | MHN | OTHER | NE7 | 01 | DC | GHMSI | OTHER | 57595101 | 01 | MD | CAREFIRST OF MARYLAND | OTHER | A159250 | 01 | DE | BLUE CROSS OF DELAWARE | OTHER | 068274 | 01 | VA | BLUE CROSS VIRGINIA | OTHER |