Provider Demographics
NPI:1568952927
Name:ALLEN, CHANAE EDWANNA
Entity Type:Individual
Prefix:
First Name:CHANAE
Middle Name:EDWANNA
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6833 SPRING BLOOM DR
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-7803
Mailing Address - Country:US
Mailing Address - Phone:614-981-3748
Mailing Address - Fax:
Practice Address - Street 1:6833 SPRING BLOOM DR
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-7803
Practice Address - Country:US
Practice Address - Phone:614-981-3748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities