Healthcare Provider Details

I. General information

NPI: 1275653768
Provider Name (Legal Business Name): CHS - GOSHEN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 STATE ROUTE 28
LOVELAND OH
45140-8723
US

IV. Provider business mailing address

25000 COUNTRY CLUB BLVD SUITE 255
NORTH OLMSTED OH
44070-5344
US

V. Phone/Fax

Practice location:
  • Phone: 513-722-0700
  • Fax: 513-722-0705
Mailing address:
  • Phone: 440-614-0160
  • Fax: 440-614-0168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRIAN COLLERAN
Title or Position: PRESIDENT
Credential:
Phone: 440-614-0168