Healthcare Provider Details

I. General information

NPI: 1033524293
Provider Name (Legal Business Name): WASHINGTON INTERGENERATIONAL ADULT DAYCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 06/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4241 EASTLAND SQUARE DR SUITE A
COLUMBUS OH
43232-5615
US

IV. Provider business mailing address

4241 EASTLAND SQUARE DR SUITE A
COLUMBUS OH
43232-5615
US

V. Phone/Fax

Practice location:
  • Phone: 614-866-0100
  • Fax: 614-866-0110
Mailing address:
  • Phone: 614-866-0100
  • Fax: 614-866-0110

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: MR. DEAN BERNARD WASHINGTON
Title or Position: PRESIDENT
Credential:
Phone: 614-866-0100