Provider Demographics
NPI:1114008570
Name:CHATSWORTH AT PGA NATIONAL LLC
Entity Type:Organization
Organization Name:CHATSWORTH AT PGA NATIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:P
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:BSN NHA
Authorized Official - Phone:561-227-3206
Mailing Address - Street 1:347 HIATT DR
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-7103
Mailing Address - Country:US
Mailing Address - Phone:561-227-3200
Mailing Address - Fax:561-227-3226
Practice Address - Street 1:347 HIATT DR
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-7106
Practice Address - Country:US
Practice Address - Phone:561-227-3200
Practice Address - Fax:561-227-3226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10 6013Medicare ID - Type Unspecified