Healthcare Provider Details

I. General information

NPI: 1518924836
Provider Name (Legal Business Name): ASHLEIGH PLACE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4435 ASHLEIGH RD
BLACKVILLE SC
29817-4463
US

IV. Provider business mailing address

4435 ASHLEIGH RD
BLACKVILLE SC
29817-4463
US

V. Phone/Fax

Practice location:
  • Phone: 803-284-4433
  • Fax: 803-284-0130
Mailing address:
  • Phone: 803-284-4433
  • Fax: 803-284-0130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberSR-0000547001-CCI
License Number StateSC

VIII. Authorized Official

Name: MRS. BRENDA DAWN HOLLINGSWORTH
Title or Position: EXECUTIVE DIRECTOR
Credential: L.S.W/L.C.S.
Phone: 803-284-4433