Provider Demographics
NPI:1073875290
Name:WASHINGTON'S INTERGENERATIONAL ADULT DAY CARE INC
Entity Type:Organization
Organization Name:WASHINGTON'S INTERGENERATIONAL ADULT DAY CARE INC
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 STE A
Mailing Address - Street 2:
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:
Practice Address - Street 1:4241 EASTLAND SQUARE DR STE A
Practice Address - Street 2:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2103093Medicaid