Healthcare Provider Details

I. General information

NPI: 1891517710
Provider Name (Legal Business Name): ELIZABETH ADULT DAYCARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1174 ROMONA PL
COLUMBUS OH
43204-4328
US

IV. Provider business mailing address

1174 ROMONA PL
COLUMBUS OH
43204-4328
US

V. Phone/Fax

Practice location:
  • Phone: 614-615-7894
  • Fax:
Mailing address:
  • Phone: 614-615-7894
  • 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: PAULINA I IYERE
Title or Position: OWNER
Credential:
Phone: 614-615-7894