MEDICARE: CCHS INC-JOHNSTOWN

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	251C00000X	Developmentally Disabled Services Day Training Agency	2500243	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841684610
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CCHS INC-JOHNSTOWN

Provider Business Mailing Address
First Line	:	540 INDUSTRIAL MILE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43228
Country	:	US
Telephone Number	:	614-279-5742
Fax Number	:	614-279-1922

Provider Business Practice Location Address
First Line	:	5006 JOHNSTOWN RD
Second Line	:
City	:	NEW ALBANY
State	:	OH
Zip	:	43054-9519
Country	:	US
Telephone Number	:	614-245-8720
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	REBECCA SHARP
Credential	:
Telephone Number	:	614-272-3272

Provider Enumeration Date	:	03/19/2015
Last Update Date	:	03/19/2015

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Directions to “CCHS INC-JOHNSTOWN ” Practice Location

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