MEDICARE: CHATEAU PLACE 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	313M00000X	Nursing Facility/Intermediate Care Facility

General Provider Information

NPI Number	:	1356336804
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHATEAU PLACE INC

Provider Business Mailing Address
First Line	:	811 N 9TH ST
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64501-1651
Country	:	US
Telephone Number	:	816-233-5164
Fax Number	:	816-233-5211

Provider Business Practice Location Address
First Line	:	811 N 9TH ST
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64501-1651
Country	:	US
Telephone Number	:	816-233-5164
Fax Number	:	816-233-5211

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. BRADLEY EUGENE HAGGARD
Credential	:	MS NURSING HOME ADMI
Telephone Number	:	816-233-5164

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	08/22/2020

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Directions to “CHATEAU PLACE INC ” Practice Location

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