MEDICARE: CHATHAM OAKS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320800000X	Mental Illness Community Based Residential Treatment Facility	R-457	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306923743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHATHAM OAKS, INC.

Provider Business Mailing Address
First Line	:	4515 MELROSE AVE
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52246-9400
Country	:	US
Telephone Number	:	319-887-2701
Fax Number	:	319-887-9154

Provider Business Practice Location Address
First Line	:	4515 MELROSE AVE
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52246-9400
Country	:	US
Telephone Number	:	319-887-2701
Fax Number	:	319-887-9154

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. VIVIAN ROMAINE DAVIS
Credential	:
Telephone Number	:	319-887-2701

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	08/22/2020

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Directions to “CHATHAM OAKS, INC. ” Practice Location

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