Healthcare Provider Details

I. General information

NPI: 1366619504
Provider Name (Legal Business Name): THE CHATEAU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 01/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 E ARTESIA BLVD
LONG BEACH CA
90805-2710
US

IV. Provider business mailing address

3100 E ARTESIA BLVD
LONG BEACH CA
90805-2710
US

V. Phone/Fax

Practice location:
  • Phone: 562-434-9932
  • Fax: 562-987-4247
Mailing address:
  • Phone: 562-428-5371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number197800131
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number197800131
License Number StateCA

VIII. Authorized Official

Name: MR. MICHAEL BOLONG
Title or Position: ADMINISTRATOR
Credential: RCS
Phone: 562-428-5371