Provider Demographics
NPI:1164635827
Name:CHATEAU BRICKYARD, INC.
Entity Type:Organization
Organization Name:CHATEAU BRICKYARD, INC.
Other - Org Name:LE CHATEAU AT BRICKYARD PLAZA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-977-1141
Mailing Address - Street 1:3080 S 1300 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3000
Mailing Address - Country:US
Mailing Address - Phone:801-466-9999
Mailing Address - Fax:801-466-7650
Practice Address - Street 1:3080 S 1300 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-3000
Practice Address - Country:US
Practice Address - Phone:801-466-9999
Practice Address - Fax:801-466-7650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities