Provider Demographics
NPI:1649087461
Name:MOSBY, ASHLEY RAELYN
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:RAELYN
Last Name:MOSBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21433 NORTH LN
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44146-5433
Mailing Address - Country:US
Mailing Address - Phone:216-392-5432
Mailing Address - Fax:
Practice Address - Street 1:21433 NORTH LN
Practice Address - Street 2:
Practice Address - City:OAKWOOD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44146-5433
Practice Address - Country:US
Practice Address - Phone:216-392-5432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities