Provider Demographics
NPI:1225008675
Name:ASHLAND DEVELOPMENT INCORPORATED
Entity Type:Organization
Organization Name:ASHLAND DEVELOPMENT INCORPORATED
Other - Org Name:PROCARE HOME HEALTH & PRIVATE DUTY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-810-0072
Mailing Address - Street 1:14805 FOREST RD STE 205
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-5019
Mailing Address - Country:US
Mailing Address - Phone:423-434-5130
Mailing Address - Fax:423-434-5149
Practice Address - Street 1:2315 SILVERDALE DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-2162
Practice Address - Country:US
Practice Address - Phone:423-434-5130
Practice Address - Fax:423-434-5149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000087251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN147905Medicaid
TN147905OtherBLUE CROSS/BLUE SHIELD
TN447214Medicare ID - Type Unspecified