Healthcare Provider Details

I. General information

NPI: 1205297249
Provider Name (Legal Business Name): CHALET OF ADRIAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2016
Last Update Date: 03/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 SAND CREEK HWY
ADRIAN MI
49221-9129
US

IV. Provider business mailing address

6101 NIMTZ PKWY
SOUTH BEND IN
46628-6111
US

V. Phone/Fax

Practice location:
  • Phone: 219-898-5705
  • Fax:
Mailing address:
  • Phone: 219-898-5705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JEFFREY SAX
Title or Position: MBR
Credential:
Phone: 219-898-5705