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NPI Code Detail

MEDICARE: CHS LAKE ERIE INC

MEDICARE: CHS LAKE ERIE INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility6256OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184612681
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHS LAKE ERIE INC
Provider Business Mailing Address
First Line : 25 CHRISTOPHER DR
Second Line :
City : FOSTORIA
State : OH
Zip : 44830-3318
Country : US
Telephone Number : 419-435-8112
Fax Number : 419-435-6220
Provider Business Practice Location Address
First Line : 25 CHRISTOPHER DR
Second Line :
City : FOSTORIA
State : OH
Zip : 44830-3318
Country : US
Telephone Number : 419-435-8112
Fax Number : 419-435-6220
Authorized Official
Title or Position : ADMINISTRATOR
Name : HOLLY BURRUS
Credential : R.N.
Telephone Number : 419-435-8112
Provider Enumeration Date : 10/10/2005
Last Update Date : 08/22/2020

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Directions to “CHS LAKE ERIE INC ” Practice Location

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