=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639893563
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAND AND HAND ADULT DAY HAB LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2022
-----------------------------------------------------
Last Update Date | 10/04/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5660 SOUTHWYCK BLVD STE 108
-----------------------------------------------------
City | TOLEDO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43614-1597
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-279-4460
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1478 HAGLEY RD
-----------------------------------------------------
City | TOLEDO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43612-2256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-279-4460
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | VONTIJA MCDUFFEY-TOWNSEND
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 419-279-4460
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------