Provider Demographics
NPI:1669641197
Name:ASHLEY HOUSE, INC.
Entity Type:Organization
Organization Name:ASHLEY HOUSE, INC.
Other - Org Name:ROAD TO RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED DRUG AND ALCOHOL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MATEJKA
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:507-847-3148
Mailing Address - Street 1:308 W ASHLEY ST
Mailing Address - Street 2:P.O. BOX 143
Mailing Address - City:JACKSON
Mailing Address - State:MN
Mailing Address - Zip Code:56143-1568
Mailing Address - Country:US
Mailing Address - Phone:507-847-3148
Mailing Address - Fax:507-847-3206
Practice Address - Street 1:308 W ASHLEY ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MN
Practice Address - Zip Code:56143-1568
Practice Address - Country:US
Practice Address - Phone:507-847-3148
Practice Address - Fax:507-847-3206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8091552324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility