MEDICARE: CHATEAU MAGNOLIA INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1356099667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHATEAU MAGNOLIA INC

Provider Business Mailing Address
First Line	:	1061 E MAGNOLIA BLVD
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91501-1315
Country	:	US
Telephone Number	:	818-625-4131
Fax Number	:

Provider Business Practice Location Address
First Line	:	1061 E MAGNOLIA BLVD
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91501-1315
Country	:	US
Telephone Number	:	818-625-4131
Fax Number	:

Authorized Official
Title or Position	:	ADMINSTRATOR
Name	:	KARINE FILIKYAN
Credential	:
Telephone Number	:	818-625-4131

Provider Enumeration Date	:	03/15/2022
Last Update Date	:	03/15/2022

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