Healthcare Provider Details

I. General information

NPI: 1750219887
Provider Name (Legal Business Name): COLUMBUS ASHLEY JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26716 OSMUN ST
MADISON HEIGHTS MI
48071-3762
US

IV. Provider business mailing address

26716 OSMUN ST
MADISON HEIGHTS MI
48071-3762
US

V. Phone/Fax

Practice location:
  • Phone: 904-480-6640
  • Fax:
Mailing address:
  • Phone: 904-480-6640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: