MEDICARE: FROM THE ASHES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center		NY

General Provider Information

NPI Number	:	1194827931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FROM THE ASHES, INC.

Provider Business Mailing Address
First Line	:	6800 JERICHO TPKE
Second Line	:	SUITE 122W
City	:	SYOSSET
State	:	NY
Zip	:	11791-4436
Country	:	US
Telephone Number	:	516-364-2220
Fax Number	:	516-364-2980

Provider Business Practice Location Address
First Line	:	6800 JERICHO TPKE
Second Line	:	SUITE 122W
City	:	SYOSSET
State	:	NY
Zip	:	11791-4436
Country	:	US
Telephone Number	:	516-364-2220
Fax Number	:	516-364-2980

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	CLAUDIA PETERS RAGNI
Credential	:	CASAC
Telephone Number	:	516-364-2220

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	08/22/2020

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