Provider Demographics
NPI:1871317032
Name:CHATEAU #1
Entity type:Organization
Organization Name:CHATEAU #1
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FAZEELA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAIKH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-810-0027
Mailing Address - Street 1:11751 MISSISSIPPI AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6130
Mailing Address - Country:US
Mailing Address - Phone:310-801-0027
Mailing Address - Fax:
Practice Address - Street 1:1860 S ORANGE GROVE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-5049
Practice Address - Country:US
Practice Address - Phone:323-297-3001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-13
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children