Provider Demographics
NPI:1083084651
Name:CHARDE ANTOINETTE
Entity Type:Organization
Organization Name:CHARDE ANTOINETTE
Other - Org Name:MACPETRUS NURSING SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARDE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRUS
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:213-798-1547
Mailing Address - Street 1:2200 W CENTURY BLVD
Mailing Address - Street 2:UNIT 47758
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047
Mailing Address - Country:US
Mailing Address - Phone:213-798-1547
Mailing Address - Fax:
Practice Address - Street 1:2923 W 138TH
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249
Practice Address - Country:US
Practice Address - Phone:213-798-1547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN228125251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health