Healthcare Provider Details

I. General information

NPI: 1639629074
Provider Name (Legal Business Name): CHATEAU BELLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 10/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15016 ARROW BLVD
FONTANA CA
92335-3153
US

IV. Provider business mailing address

15016 ARROW BLVD
FONTANA CA
92335-3153
US

V. Phone/Fax

Practice location:
  • Phone: 909-717-9856
  • Fax: 909-371-0733
Mailing address:
  • Phone: 909-717-9856
  • Fax: 909-371-0733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. MICHAEL DEMETRI WINCHESTER
Title or Position: CEO
Credential: N/A
Phone: 909-717-9856