MEDICARE: CCHI, 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	314000000X	Skilled Nursing Facility	SNF130470998	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	35960937	OTHER	FL	STATE FACILITY MDS ID NUM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174519300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CCHI, LLC

Provider Business Mailing Address
First Line	:	583 NE 351 HWY
Second Line	:
City	:	CROSS CITY
State	:	FL
Zip	:	32628-3108
Country	:	US
Telephone Number	:	352-498-2005
Fax Number	:	352-498-2006

Provider Business Practice Location Address
First Line	:	583 NE 351 HWY
Second Line	:
City	:	CROSS CITY
State	:	FL
Zip	:	32628-3108
Country	:	US
Telephone Number	:	352-498-2005
Fax Number	:	352-498-2006

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. DONITA TANNENBAUM
Credential	:	RN, LNHA
Telephone Number	:	352-498-2005

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	06/25/2008

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Directions to “CCHI, LLC ” Practice Location

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