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General NPI Number Information
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NPI Number | 1316873763
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Entity Type | Organization
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Legal Business Name | FUNDAMENTALS ADULT DAY SERVICES, INC.
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Dates
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Enumeration Date | 06/23/2026
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Last Update Date | 06/23/2026
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Provider Practice Location Address
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Address Line | 12500 BUCKEYE RD
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City | CLEVELAND
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State | OH
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Zip | 44120-2652
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Country | US
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Telephone | 216-407-6148
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Fax |
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Provider Business Mailing Address
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Address Line | 2884 CAMELOT CT
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City | WILLOUGHBY HILLS
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State | OH
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Zip | 44092-1466
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Country | US
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Telephone | 216-407-6148
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JIYAVAUGHNA WHITE
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Credential |
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Telephone | 216-882-9932
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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