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General NPI Number Information
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NPI Number | 1669641197
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Entity Type | Organization
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Legal Business Name | ASHLEY HOUSE, INC.
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Dates
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Enumeration Date | 02/28/2008
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Last Update Date | 02/28/2008
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Provider Practice Location Address
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Address Line | 308 W ASHLEY ST
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City | JACKSON
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State | MN
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Zip | 56143-1568
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Country | US
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Telephone | 507-847-3148
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Fax | 507-847-3206
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Provider Business Mailing Address
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Address Line | 308 W ASHLEY ST P.O. BOX 143
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City | JACKSON
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State | MN
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Zip | 56143-1568
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Country | US
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Telephone | 507-847-3148
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Fax | 507-847-3206
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Authorized Official
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Title or Position | LICENSED DRUG AND ALCOHOL COUNSELOR
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Name | MARILYN A. MATEJKA
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Credential | L.A.D.C.
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Telephone | 507-847-3148
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 8091552
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License Number State | MN
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