Healthcare Provider Details

I. General information

NPI: 1316873763
Provider Name (Legal Business Name): FUNDAMENTALS ADULT DAY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12500 BUCKEYE RD
CLEVELAND OH
44120-2652
US

IV. Provider business mailing address

2884 CAMELOT CT
WILLOUGHBY HILLS OH
44092-1466
US

V. Phone/Fax

Practice location:
  • Phone: 216-407-6148
  • Fax:
Mailing address:
  • Phone: 216-407-6148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JIYAVAUGHNA WHITE
Title or Position: CEO
Credential:
Phone: 216-882-9932