Provider Demographics
NPI:1558345728
Name:CHS - LAKE ERIE, INC
Entity type:Organization
Organization Name:CHS - LAKE ERIE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-682-2700
Mailing Address - Street 1:8200 BECKETT PARK DR
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-8955
Mailing Address - Country:US
Mailing Address - Phone:513-682-2700
Mailing Address - Fax:513-682-2716
Practice Address - Street 1:7600 S RIDGE RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-9746
Practice Address - Country:US
Practice Address - Phone:440-428-1492
Practice Address - Fax:440-428-8698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0043-NH314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2339642Medicaid
OH365306Medicare ID - Type Unspecified