Healthcare Provider Details

I. General information

NPI: 1669065777
Provider Name (Legal Business Name): 1169 BRYDEN PLACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2021
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1169 BRYDEN RD
COLUMBUS OH
43205-1979
US

IV. Provider business mailing address

1169 BRYDEN RD
COLUMBUS OH
43205-1979
US

V. Phone/Fax

Practice location:
  • Phone: 614-927-2700
  • Fax:
Mailing address:
  • Phone: 614-927-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: JULIA ANN MOUTON MONROE
Title or Position: EXECUTIVE DIRECTOR
Credential: LPN, CPD, CDAL, PCHA
Phone: 614-927-2700