Provider Demographics
NPI:1437382280
Name:ELMWOOD ADULT DAY HEALTH CARE CENTER
Entity Type:Organization
Organization Name:ELMWOOD ADULT DAY HEALTH CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:YATSKAR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:617-442-3462
Mailing Address - Street 1:70 WARREN ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-3248
Mailing Address - Country:US
Mailing Address - Phone:617-442-3462
Mailing Address - Fax:617-445-7874
Practice Address - Street 1:209 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-1460
Practice Address - Country:US
Practice Address - Phone:401-421-6300
Practice Address - Fax:401-459-4005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day CareGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty