Healthcare Provider Details

I. General information

NPI: 1073875290
Provider Name (Legal Business Name): WASHINGTON'S INTERGENERATIONAL ADULT DAY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 06/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

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