MEDICARE: CAPE CHATEAU 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	310400000X	Assisted Living Facility	8573	FL

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
2	1425064000	OTHER	FL	ACS

General Provider Information

NPI Number	:	1720323587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPE CHATEAU INC

Provider Business Mailing Address
First Line	:	804 SE 16TH PL
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-1645
Country	:	US
Telephone Number	:	239-218-6190
Fax Number	:	239-574-8436

Provider Business Practice Location Address
First Line	:	804 SE 16TH PL
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-1645
Country	:	US
Telephone Number	:	239-218-6190
Fax Number	:	239-574-8436

Authorized Official
Title or Position	:	PRESIDENT ADMINISTRATOR
Name	:	LORRAINE GNOLFO
Credential	:
Telephone Number	:	239-218-6190

Provider Enumeration Date	:	12/05/2012
Last Update Date	:	12/05/2012

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Directions to “CAPE CHATEAU INC ” Practice Location

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