MEDICARE: CHATEAU #1

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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility

General Provider Information

NPI Number	:	1871317032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHATEAU #1

Provider Business Mailing Address
First Line	:	11751 MISSISSIPPI AVENUE
Second Line	:	SUITE 100
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-6130
Country	:	US
Telephone Number	:	310-801-0027
Fax Number	:

Provider Business Practice Location Address
First Line	:	1860 S ORANGE GROVE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-5049
Country	:	US
Telephone Number	:	323-297-3001
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	FAZEELA SHAIKH
Credential	:
Telephone Number	:	310-810-0027

Provider Enumeration Date	:	11/13/2024
Last Update Date	:	09/02/2025

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