MEDICARE: ASHLEY GREEN BAILEY

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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1932891603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY GREEN BAILEY

Provider Business Mailing Address
First Line	:	7106 ESCONDIDO DR
Second Line	:
City	:	ROSHARON
State	:	TX
Zip	:	77583-4480
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9888 BISSONNET ST STE 320
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-8297
Country	:	US
Telephone Number	:	832-763-3152
Fax Number	:

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

Provider Enumeration Date	:	05/22/2023
Last Update Date	:	05/22/2023

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Directions to “ ASHLEY GREEN BAILEY ” Practice Location

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