Healthcare Provider Details

I. General information

NPI: 1003421421
Provider Name (Legal Business Name): CHATEL BEHAVIORAL HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7908 MODESTO DR
ARLINGTON TX
76001-6102
US

IV. Provider business mailing address

PO BOX 181074
ARLINGTON TX
76096-1074
US

V. Phone/Fax

Practice location:
  • Phone: 817-501-5459
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL OMOROGBE
Title or Position: CEO
Credential:
Phone: 817-501-5459