Provider Demographics
NPI:1699085787
Name:MADELINE CHATEAU
Entity type:Organization
Organization Name:MADELINE CHATEAU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:AZOUKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-410-1688
Mailing Address - Street 1:8118 DIABLO COURT
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655
Mailing Address - Country:US
Mailing Address - Phone:727-410-1688
Mailing Address - Fax:727-376-6025
Practice Address - Street 1:8118 DIABLO CT
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-5126
Practice Address - Country:US
Practice Address - Phone:727-410-1688
Practice Address - Fax:727-376-6025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906223311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home