Provider Demographics
NPI:1154674513
Name:CHS OF BOWERSTON OPERATING COMPANY INC
Entity Type:Organization
Organization Name:CHS OF BOWERSTON OPERATING COMPANY INC
Other - Org Name:SUNNYSLOPE NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERNSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-277-0505
Mailing Address - Street 1:5020 PHILADELPHIA DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-3653
Mailing Address - Country:US
Mailing Address - Phone:937-277-0505
Mailing Address - Fax:937-277-4234
Practice Address - Street 1:102 BOYCE DR
Practice Address - Street 2:
Practice Address - City:BOWERSTON
Practice Address - State:OH
Practice Address - Zip Code:44695-9701
Practice Address - Country:US
Practice Address - Phone:740-269-8001
Practice Address - Fax:740-269-1733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility