MEDICARE: CHASEI WALLACE

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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility
2	347C00000X	Private Vehicle

General Provider Information

NPI Number	:	1861375677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHASEI WALLACE

Provider Business Mailing Address
First Line	:	5715 SIGNAL POINTE DR APT 102
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45247-3285
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5715 SIGNAL POINTE DR APT 102
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45247-3285
Country	:	US
Telephone Number	:	513-686-0798
Fax Number	:

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

Provider Enumeration Date	:	07/29/2025
Last Update Date	:	09/15/2025

Similar Medicare Providers

1720069776 — DR. SET SHAHBABIAN MD
Practice Location Address:

3285 WESTBOURNE DR
CINCINNATI, OH
45248-5130

Practice Phone: 513-922-4810
Practice Fax: 513-922-3421

1114037991 — ARTHUR L HUGHES MD
Practice Location Address:

3285 WESTBOURNE DR
CINCINNATI, OH
45248-5143

Practice Phone: 513-451-6200
Practice Fax: 513-451-0344

1104945062 — SET SHAHBABIAN MD INC
Practice Location Address:

3285 WESTBOURNE DR
CINCINNATI, OH
45248-5130

Practice Phone: 513-922-4810
Practice Fax: 513-922-3421

1043473812 — UNIVERSITY RADIOLOGY ASSOCIATES OF CINCINNATI, INC.
Practice Location Address:

3285 WESTBOURNE DR
CINCINNATI, OH
45248-5130

Practice Phone: 513-451-7500
Practice Fax: 513-347-2594

1689920936 — MRS. DOROTHY RENEE IDRIS RN
Practice Location Address:

3285 RENFRO AVE
CINCINNATI, OH
45211-6624

Practice Phone: 513-546-8002
Practice Fax:

1831513936 — TRIHEALTHOS, LLC
Practice Location Address:

3285 WESTBOURNE DR , SUITE 1
CINCINNATI, OH
45248-5144

Practice Phone: 513-922-4810
Practice Fax: 513-922-3421

Directions to “ CHASEI WALLACE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.