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General NPI Number Information
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NPI Number | 1144968215
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Entity Type | Individual
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Provider Name | CHEYENNE DAVIS
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Gender | Female
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Dates
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Enumeration Date | 05/26/2022
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Last Update Date | 05/26/2022
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Provider Practice Location Address
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Address Line | 3905 LORRAINE PATH
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-8630
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Country | US
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Telephone | 269-428-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 196 ELM ST
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City | ROSSFORD
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State | OH
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Zip | 43460-1223
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Country | US
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Telephone | 419-340-5949
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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