Provider Demographics
NPI:1427648815
Name:CHS
Entity type:Organization
Organization Name:CHS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:DAVON
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:352-256-5662
Mailing Address - Street 1:104 SE 13TH LN
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-8617
Mailing Address - Country:US
Mailing Address - Phone:352-256-5662
Mailing Address - Fax:
Practice Address - Street 1:226 NE SANCHEZ AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-5871
Practice Address - Country:US
Practice Address - Phone:352-843-2168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-20
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty