Healthcare Provider Details

I. General information

NPI: 1114008570
Provider Name (Legal Business Name): CHATSWORTH AT PGA NATIONAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 HIATT DR
PALM BEACH GARDENS FL
33418-7106
US

IV. Provider business mailing address

347 HIATT DR
PALM BEACH GARDENS FL
33418-7103
US

V. Phone/Fax

Practice location:
  • Phone: 561-227-3200
  • Fax: 561-227-3226
Mailing address:
  • Phone: 561-227-3200
  • Fax: 561-227-3226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GAIL P COCHRAN
Title or Position: ADMINISTRATOR
Credential: BSN NHA
Phone: 561-227-3206