MEDICARE: ASHLEY M BURGESS

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	251E00000X	Home Health Agency
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1700342979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY M BURGESS

Provider Business Mailing Address
First Line	:	3935 LEE HEIGHTS BLVD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-1734
Country	:	US
Telephone Number	:	216-556-4608
Fax Number	:

Provider Business Practice Location Address
First Line	:	3935 LEE HEIGHTS BLVD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-1734
Country	:	US
Telephone Number	:	216-556-4608
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2019
Last Update Date	:	05/01/2020

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Directions to “ ASHLEY M BURGESS ” Practice Location

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