Provider Demographics
NPI:1093390379
Name:CHLOE'S PLACE I
Entity Type:Organization
Organization Name:CHLOE'S PLACE I
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MRS.
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-273-3936
Mailing Address - Street 1:2460 KATHI KIM ST
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32926-5372
Mailing Address - Country:US
Mailing Address - Phone:321-637-8985
Mailing Address - Fax:
Practice Address - Street 1:2460 KATHI KIM ST
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32926-5372
Practice Address - Country:US
Practice Address - Phone:321-637-8985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility