Provider Demographics
NPI:1750063103
Name:ELDER ENRICHMENT CENTER
Entity type:Organization
Organization Name:ELDER ENRICHMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:HOUSER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:513-416-8286
Mailing Address - Street 1:112 N MARSHALL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-3822
Mailing Address - Country:US
Mailing Address - Phone:513-416-8286
Mailing Address - Fax:
Practice Address - Street 1:5049 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-5436
Practice Address - Country:US
Practice Address - Phone:513-416-8286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care