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General NPI Number Information
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NPI Number | 1669065777
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Entity Type | Organization
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Legal Business Name | 1169 BRYDEN PLACE LLC
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Dates
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Enumeration Date | 02/19/2021
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Last Update Date | 02/19/2021
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Provider Practice Location Address
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Address Line | 1169 BRYDEN RD
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City | COLUMBUS
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State | OH
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Zip | 43205-1979
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Country | US
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Telephone | 614-927-2700
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Fax |
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Provider Business Mailing Address
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Address Line | 1169 BRYDEN RD
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City | COLUMBUS
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State | OH
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Zip | 43205-1979
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Country | US
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Telephone | 614-927-2700
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JULIA ANN MOUTON MONROE
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Credential | LPN, CPD, CDAL, PCHA
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Telephone | 614-927-2700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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