Provider Demographics
NPI:1699492751
Name:CHASTELLA INC
Entity type:Organization
Organization Name:CHASTELLA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:
Authorized Official - Last Name:OHAERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-649-6111
Mailing Address - Street 1:PO BOX 1170
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92556-1170
Mailing Address - Country:US
Mailing Address - Phone:909-370-2858
Mailing Address - Fax:
Practice Address - Street 1:11950 STEEPLECHASE DR
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-1750
Practice Address - Country:US
Practice Address - Phone:951-485-6999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-20
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty