Basic Information
| Provider Information | |||||||||
| NPI: | 1790769933 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHS - GARDEN GATE, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | THE RESIDENCE AT GARDEN GATE | ||||||||
| 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: | 6922 OHIO AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452363506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137932090 | ||||||||
| FaxNumber: | 5137934840 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2005 | ||||||||
| LastUpdateDate: | 03/29/2011 | ||||||||
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| AuthorizedOfficialLastName: | RICE | ||||||||
| AuthorizedOfficialFirstName: | WANDA | ||||||||
| AuthorizedOfficialMiddleName: | JEAN | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5136822700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 0100N | OH | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 2485654 | 05 | OH | MEDICAID |