Healthcare Provider Details

I. General information

NPI: 1437382280
Provider Name (Legal Business Name): ELMWOOD ADULT DAY HEALTH CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 ELMWOOD AVE
PROVIDENCE RI
02907-1460
US

IV. Provider business mailing address

70 WARREN ST SUITE 8
ROXBURY MA
02119-3248
US

V. Phone/Fax

Practice location:
  • Phone: 401-421-6300
  • Fax: 401-459-4005
Mailing address:
  • Phone: 617-442-3462
  • Fax: 617-445-7874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. IGOR YATSKAR
Title or Position: PRESIDENT
Credential: P.T.
Phone: 617-442-3462