1033253489 NPI number — ACTIVE DAY OH, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033253489 NPI number — ACTIVE DAY OH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACTIVE DAY OH, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ACTIVE DAY OF COLUMBUS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033253489
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 REDLAND CT
Provider Second Line Business Mailing Address:
SUITE 114
Provider Business Mailing Address City Name:
OWINGS MILLS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21117-3270
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-548-2200
Provider Business Mailing Address Fax Number:
443-548-2260

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 BETHEL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43220-1807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-538-8870
Provider Business Practice Location Address Fax Number:
614-538-8846
Provider Enumeration Date:
02/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BALDOCK
Authorized Official First Name:
KRIS
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
CHAIRMAN, CEO, PRESIDENT
Authorized Official Telephone Number:
443-548-2201

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2584341 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2617305 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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