Basic Information
| Provider Information | |||||||||
| NPI: | 1194140921 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHANTE MEADOWS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1350 W 5TH AVE STE 112 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432122907 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1350 W 5TH AVE STE 112 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432122907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142331062 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2014 | ||||||||
| LastUpdateDate: | 05/04/2021 | ||||||||
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| AuthorizedOfficialLastName: | MEADOWS | ||||||||
| AuthorizedOfficialFirstName: | CHANTE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6142331062 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LISW-S | ||||||||
| NPICertificationDate: | 05/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | I1101245-SUPV | OH | Y | Agencies | Community/Behavioral Health |
No ID Information.