Provider Demographics
NPI:1033524293
Name:WASHINGTON INTERGENERATIONAL ADULT DAYCARE
Entity Type:Organization
Organization Name:WASHINGTON INTERGENERATIONAL ADULT DAYCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-866-0100
Mailing Address - Street 1:4241 EASTLAND SQUARE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-5615
Mailing Address - Country:US
Mailing Address - Phone:614-866-0100
Mailing Address - Fax:614-866-0110
Practice Address - Street 1:4241 EASTLAND SQUARE DR
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-5615
Practice Address - Country:US
Practice Address - Phone:614-866-0100
Practice Address - Fax:614-866-0110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2103093Medicaid