Healthcare Provider Details

I. General information

NPI: 1649343724
Provider Name (Legal Business Name): CHATEAU DE SOUTH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 S 5TH ST
CHICKASHA OK
73018-3409
US

IV. Provider business mailing address

205 S 5TH ST
CHICKASHA OK
73018-3409
US

V. Phone/Fax

Practice location:
  • Phone: 405-222-4480
  • Fax: 405-222-4480
Mailing address:
  • Phone: 405-222-4480
  • Fax: 405-222-4480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberDC2603-2603
License Number StateOK

VIII. Authorized Official

Name: MR. DAVID J. CALTON
Title or Position: PRESIDENT
Credential:
Phone: 405-222-4480