Basic Information
| Provider Information | |||||||||
| NPI: | 1083698278 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHS - LAKE ERIE, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ST. CATHERINE'S CARE CENTER OF WASHINGTON COURT HOUSE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8200 BECKETT PARK DR | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450118955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136822700 | ||||||||
| FaxNumber: | 5136822716 | ||||||||
| Practice Location | |||||||||
| Address1: | 8200 BECKETT PARK DR | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450118955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403356391 | ||||||||
| FaxNumber: | 7403353513 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | RICE | ||||||||
| AuthorizedOfficialFirstName: | WANDA | ||||||||
| AuthorizedOfficialMiddleName: | JEAN | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5136822700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 0338-NH | OH | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 2339446 | 05 | OH | MEDICAID |