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General NPI Number Information
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NPI Number | 1639629074
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Entity Type | Organization
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Legal Business Name | CHATEAU BELLE
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Dates
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Enumeration Date | 10/10/2016
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Last Update Date | 10/10/2016
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Provider Practice Location Address
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Address Line | 15016 ARROW BLVD
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City | FONTANA
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State | CA
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Zip | 92335-3153
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Country | US
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Telephone | 909-717-9856
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Fax | 909-371-0733
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Provider Business Mailing Address
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Address Line | 15016 ARROW BLVD
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City | FONTANA
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State | CA
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Zip | 92335-3153
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Country | US
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Telephone | 909-717-9856
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Fax | 909-371-0733
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Authorized Official
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Title or Position | CEO
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Name | MR. MICHAEL DEMETRI WINCHESTER
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Credential | N/A
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Telephone | 909-717-9856
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State | CA
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