Healthcare Provider Details

I. General information

NPI: 1720221641
Provider Name (Legal Business Name): SECOND HOME ADULT DAYCARE & TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 05/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2556 MORSE RD.
COLUMBUS OH
43231
US

IV. Provider business mailing address

2556 MORSE RD
COLUMBUS OH
43231
US

V. Phone/Fax

Practice location:
  • Phone: 614-329-8486
  • Fax: 614-414-0666
Mailing address:
  • Phone: 614-329-8486
  • Fax: 614-414-0666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number1563972
License Number StateOH

VIII. Authorized Official

Name: UBAH A ALI
Title or Position: ADMINISTRATOR
Credential:
Phone: 614-414-0077