MEDICARE: CHI LIVING COMMUNITIES

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		IA

General Provider Information

NPI Number	:	1568810372
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHI LIVING COMMUNITIES

Provider Business Mailing Address
First Line	:	5837 WINWOOD DR
Second Line	:
City	:	JOHNSTON
State	:	IA
Zip	:	50131-1651
Country	:	US
Telephone Number	:	515-270-1100
Fax Number	:	515-276-1714

Provider Business Practice Location Address
First Line	:	5942 RENAISSANCE PL
Second Line	:	SUITE A
City	:	TOLEDO
State	:	OH
Zip	:	43623-4716
Country	:	US
Telephone Number	:	567-455-0414
Fax Number	:

Authorized Official
Title or Position	:	SECRETARY & COO
Name	:	WENDY DOLYK
Credential	:
Telephone Number	:	567-455-0414

Provider Enumeration Date	:	06/02/2016
Last Update Date	:	06/02/2016

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Directions to “CHI LIVING COMMUNITIES ” Practice Location

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