Healthcare Provider Details

I. General information

NPI: 1699085787
Provider Name (Legal Business Name): MADELINE CHATEAU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2010
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8118 DIABLO CT
TRINITY FL
34655-5126
US

IV. Provider business mailing address

8118 DIABLO COURT
TRINITY FL
34655
US

V. Phone/Fax

Practice location:
  • Phone: 727-410-1688
  • Fax: 727-376-6025
Mailing address:
  • Phone: 727-410-1688
  • Fax: 727-376-6025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number6906223
License Number StateFL

VIII. Authorized Official

Name: MS. MADELINE AZOUKI
Title or Position: OWNER
Credential:
Phone: 727-410-1688