=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467260182
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHARDON WOODS OF JOURNEY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/27/2024
-----------------------------------------------------
Last Update Date | 12/27/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12340 BASS LAKE RD
-----------------------------------------------------
City | CHARDON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44024-8327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-285-4040
-----------------------------------------------------
Fax | 440-285-7743
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 949 CONNER ST FL 2
-----------------------------------------------------
City | NOBLESVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46060-2622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 463-278-0868
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | BERNARD J. MCGUINNESS III
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 463-278-0868
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------