Provider Demographics
NPI:1912756180
Name:CHATEAU ANGEL ROSE LLC.
Entity type:Organization
Organization Name:CHATEAU ANGEL ROSE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:R
Authorized Official - Last Name:ELROD
Authorized Official - Suffix:
Authorized Official - Credentials:PEER SUPPORT
Authorized Official - Phone:541-891-9861
Mailing Address - Street 1:3882 RIO VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-7727
Mailing Address - Country:US
Mailing Address - Phone:541-891-9861
Mailing Address - Fax:
Practice Address - Street 1:3882 RIO VISTA WAY
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-7727
Practice Address - Country:US
Practice Address - Phone:541-891-9861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-18
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty