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
1	314000000X	Skilled Nursing Facility	0043-NH	OH

Other Identifiers

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

General Provider Information

NPI Number	:	1558345728
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHS - LAKE ERIE, INC

Provider Business Mailing Address
First Line	:	8200 BECKETT PARK DR
Second Line	:
City	:	HAMILTON
State	:	OH
Zip	:	45011-8955
Country	:	US
Telephone Number	:	513-682-2700
Fax Number	:	513-682-2716

Provider Business Practice Location Address
First Line	:	7600 S RIDGE RD
Second Line	:
City	:	MADISON
State	:	OH
Zip	:	44057-9746
Country	:	US
Telephone Number	:	440-428-1492
Fax Number	:	440-428-8698

Authorized Official
Title or Position	:	CEO
Name	:	MS. WANDA JEAN RICE
Credential	:
Telephone Number	:	513-682-2700

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	08/22/2020

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