=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720323587
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAPE CHATEAU INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2012
-----------------------------------------------------
Last Update Date | 12/05/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 804 SE 16TH PL
-----------------------------------------------------
City | CAPE CORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33990-1645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-218-6190
-----------------------------------------------------
Fax | 239-574-8436
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 804 SE 16TH PL
-----------------------------------------------------
City | CAPE CORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33990-1645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-218-6190
-----------------------------------------------------
Fax | 239-574-8436
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT ADMINISTRATOR
-----------------------------------------------------
Name | LORRAINE GNOLFO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 239-218-6190
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 8573
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------