Healthcare Provider Details

I. General information

NPI: 1659370989
Provider Name (Legal Business Name): CHATEAU LIVING CENTER, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 VILLAGE RD
KENNER LA
70065-2751
US

IV. Provider business mailing address

716 VILLAGE RD
KENNER LA
70065-2751
US

V. Phone/Fax

Practice location:
  • Phone: 504-464-0604
  • Fax: 504-464-0808
Mailing address:
  • Phone: 504-464-0604
  • Fax: 504-464-0808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number716
License Number StateLA

VIII. Authorized Official

Name: MR. JOHN ROBERT LASTER
Title or Position: ADMINISTRATOR
Credential:
Phone: 504-464-0604