Provider Demographics
NPI:1245787654
Name:CHARLES S. BOGAN
Entity Type:Organization
Organization Name:CHARLES S. BOGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PRACTICAL NURSE
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:BOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-804-6678
Mailing Address - Street 1:4656 WALFORD RD
Mailing Address - Street 2:APARTMENT 114
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44128-7153
Mailing Address - Country:US
Mailing Address - Phone:216-804-6678
Mailing Address - Fax:
Practice Address - Street 1:4656 WALFORD RD
Practice Address - Street 2:APARTMENT 114
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44128-7153
Practice Address - Country:US
Practice Address - Phone:216-804-6678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.127610311ZA0620X, 3140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home