Provider Demographics
NPI:1427407873
Name:CHI LIVING COMMUNITIES
Entity Type:Organization
Organization Name:CHI LIVING COMMUNITIES
Other - Org Name:MEDALION HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY & COO
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOLYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-455-0414
Mailing Address - Street 1:1719 E BIJOU ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5736
Mailing Address - Country:US
Mailing Address - Phone:719-381-1000
Mailing Address - Fax:
Practice Address - Street 1:5942 RENAISSANCE PL
Practice Address - Street 2:SUITE A
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4716
Practice Address - Country:US
Practice Address - Phone:567-455-0414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SYLVANIA FRANCISCAN HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility