MEDICARE: CHAPPY5-2 LLC

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1083399356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAPPY5-2 LLC

Provider Business Mailing Address
First Line	:	100 LILLIAN GISH BLVD SW STE 203
Second Line	:
City	:	MASSILLON
State	:	OH
Zip	:	44647-6500
Country	:	US
Telephone Number	:	330-809-6444
Fax Number	:	330-237-9404

Provider Business Practice Location Address
First Line	:	100 LILLIAN GISH BLVD SW STE 203
Second Line	:
City	:	MASSILLON
State	:	OH
Zip	:	44647-6500
Country	:	US
Telephone Number	:	330-809-6444
Fax Number	:	330-237-9404

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	MR. JOHN B. CHAPMAN
Credential	:
Telephone Number	:	330-809-6444

Provider Enumeration Date	:	06/15/2023
Last Update Date	:	06/15/2023

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Directions to “CHAPPY5-2 LLC ” Practice Location

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