Healthcare Provider Details

I. General information

NPI: 1518287796
Provider Name (Legal Business Name): IDEAL ADULT DAYCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 06/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 E BROAD ST SUITE 125
COLUMBUS OH
43213-1156
US

IV. Provider business mailing address

4040 E BROAD ST SUITE 125
COLUMBUS OH
43213-1156
US

V. Phone/Fax

Practice location:
  • Phone: 614-483-2441
  • Fax:
Mailing address:
  • Phone:
  • 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: ANNA KRUPOVLYANSKAYA
Title or Position: CEO
Credential:
Phone: 614-483-2441