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General NPI Number Information
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NPI Number | 1881039295
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Entity Type | Organization
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Legal Business Name | CHATEAU ADULT DAY CENTER, LLC
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Dates
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Enumeration Date | 04/30/2013
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Last Update Date | 04/30/2013
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Provider Practice Location Address
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Address Line | 111 E 13TH ST
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City | LAUREL
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State | MS
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Zip | 39440-3014
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Country | US
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Telephone | 601-310-0296
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1132
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City | LAUREL
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State | MS
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Zip | 39441-1132
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Country | US
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Telephone | 601-310-0296
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | SHUNDRA WALKER
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Credential |
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Telephone | 601-310-0296
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State | MS
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