Healthcare Provider Details

I. General information

NPI: 1104373562
Provider Name (Legal Business Name): ASHLEY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2016
Last Update Date: 09/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W HIGH ST
ELKTON MD
21921-5529
US

IV. Provider business mailing address

800 TYDINGS LN
HAVRE DE GRACE MD
21078-2102
US

V. Phone/Fax

Practice location:
  • Phone: 443-760-3620
  • Fax: 443-371-2638
Mailing address:
  • Phone: 800-799-4673
  • Fax: 410-273-2290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number100634
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number100634
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number100634
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number100634
License Number StateMD

VIII. Authorized Official

Name: ALBERT GERMANN
Title or Position: CFO
Credential: CPA
Phone: 410-273-2207