Healthcare Provider Details

I. General information

NPI: 1407831738
Provider Name (Legal Business Name): CHS - LAKE ERIE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 CHRISTOPHER DR
FOSTORIA OH
44830-3318
US

IV. Provider business mailing address

8200 BECKETT PARK DR
HAMILTON OH
45011-8955
US

V. Phone/Fax

Practice location:
  • Phone: 419-435-8112
  • Fax: 419-435-0334
Mailing address:
  • Phone: 513-682-2700
  • Fax: 513-682-2716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1374-NH
License Number StateOH

VIII. Authorized Official

Name: MS. WANDA JEAN RICE
Title or Position: CEO
Credential:
Phone: 513-682-2700