MEDICARE: CHANAE EDWANNA ALLEN

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	320700000X	Physical Disabilities Residential Treatment Facility
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1568952927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANAE EDWANNA ALLEN

Provider Business Mailing Address
First Line	:	6833 SPRING BLOOM DR
Second Line	:
City	:	CANAL WINCHESTER
State	:	OH
Zip	:	43110-7803
Country	:	US
Telephone Number	:	614-981-3748
Fax Number	:

Provider Business Practice Location Address
First Line	:	2211 LAKE CLUB DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-3204
Country	:	US
Telephone Number	:	614-704-5224
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2018
Last Update Date	:	09/10/2024

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Directions to “ CHANAE EDWANNA ALLEN ” Practice Location

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