Provider Demographics
NPI:1740520758
Name:ASHLEY, RONNETTE ROCHELLE
Entity type:Individual
Prefix:MISS
First Name:RONNETTE
Middle Name:ROCHELLE
Last Name:ASHLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:RONNETTE
Other - Middle Name:ROCHELLE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:492 SPEARMAN RD
Mailing Address - Street 2:
Mailing Address - City:BOLTON
Mailing Address - State:NC
Mailing Address - Zip Code:28423-8622
Mailing Address - Country:US
Mailing Address - Phone:910-655-9827
Mailing Address - Fax:
Practice Address - Street 1:492 SPEARMAN RD
Practice Address - Street 2:
Practice Address - City:BOLTON
Practice Address - State:NC
Practice Address - Zip Code:28423-8622
Practice Address - Country:US
Practice Address - Phone:910-655-9827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL024014311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home