MEDICARE: A CHARMING CHANCE HEALTHCARE

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	253Z00000X	In Home Supportive Care Agency

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	:	1881315653
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A CHARMING CHANCE HEALTHCARE

Provider Business Mailing Address
First Line	:	5660 SOUTHWYCK BLVD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-1566
Country	:	US
Telephone Number	:	419-725-2425
Fax Number	:

Provider Business Practice Location Address
First Line	:	5660 SOUTHWYCK BLVD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-1566
Country	:	US
Telephone Number	:	419-725-2425
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATION/ OWNER
Name	:	SHATARA BROWN
Credential	:
Telephone Number	:	419-908-9331

Provider Enumeration Date	:	09/08/2022
Last Update Date	:	09/08/2022

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