MEDICARE: NORTHERN LIGHTS ACTIVE DAY CENTER.LLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1679058010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN LIGHTS ACTIVE DAY CENTER.LLP

Provider Business Mailing Address
First Line	:	3551 CLEVELAND AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-2909
Country	:	US
Telephone Number	:	614-822-1399
Fax Number	:

Provider Business Practice Location Address
First Line	:	3551 CLEVELAND AVE STE B
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-2909
Country	:	US
Telephone Number	:	614-822-1399
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	FAISAL I ADEN
Credential	:
Telephone Number	:	614-822-1399

Provider Enumeration Date	:	10/02/2018
Last Update Date	:	06/05/2024

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