MEDICARE: CHS - SPRINGDALE, 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	2454N	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	:	1982641221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHS - SPRINGDALE, INC

Provider Business Mailing Address
First Line	:	3564 SPRINGDALE RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45251-1331
Country	:	US
Telephone Number	:	513-741-4888
Fax Number	:	513-741-4890

Provider Business Practice Location 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	:	513-682-2709

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	03/29/2011

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