MEDICARE: MR. DAVID F CHAPMAN OWNER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	310400000X	Assisted Living Facility
2	3104A0630X	Assisted Living Facility (Behavioral Disturbances)
3	343900000X	Non-emergency Medical Transport (VAN)
4	3104A0625X	Assisted Living Facility (Mental Illness)

General Provider Information

NPI Number	:	1932788015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID F CHAPMAN OWNER

Provider Business Mailing Address
First Line	:	6912 WALES CROSS ST NW
Second Line	:	APT C
City	:	NORTH CANTON
State	:	OH
Zip	:	44720
Country	:	US
Telephone Number	:	330-685-5148
Fax Number	:

Provider Business Practice Location Address
First Line	:	6912 WALES CROSS ST NW
Second Line	:	APT C
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-4472
Country	:	US
Telephone Number	:	330-685-5148
Fax Number	:

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

Provider Enumeration Date	:	04/06/2021
Last Update Date	:	04/06/2021

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