Provider Demographics
NPI:1720777261
Name:ASHLEY'S MOONSHADOW, INC.
Entity Type:Organization
Organization Name:ASHLEY'S MOONSHADOW, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:AINSLIE
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:RESCHKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-223-8251
Mailing Address - Street 1:8370 MUNSON RD
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-2409
Mailing Address - Country:US
Mailing Address - Phone:440-223-8251
Mailing Address - Fax:
Practice Address - Street 1:8370 MUNSON RD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-2409
Practice Address - Country:US
Practice Address - Phone:440-223-8251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)