=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801873989
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASHLEY, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2005
-----------------------------------------------------
Last Update Date | 08/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 TYDINGS LN
-----------------------------------------------------
City | HAVRE DE GRACE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21078-2132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-273-6600
-----------------------------------------------------
Fax | 410-272-5617
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800 TYDINGS LN
-----------------------------------------------------
City | HAVRE DE GRACE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21078-2102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-273-2213
-----------------------------------------------------
Fax | 410-344-2416
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT OF CLINICAL SERVICES
-----------------------------------------------------
Name | JENNIFER AGUGLIA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 410-273-2462
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number | 13906
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------