Provider Demographics
NPI:1164863395
Name:JOSEPH'S CHATEAU LLC
Entity Type:Organization
Organization Name:JOSEPH'S CHATEAU LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MOREY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:651-815-9250
Mailing Address - Street 1:12715 42ND PL N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55442-2350
Mailing Address - Country:US
Mailing Address - Phone:651-815-9250
Mailing Address - Fax:651-688-0088
Practice Address - Street 1:12715 42ND PL N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55442-2350
Practice Address - Country:US
Practice Address - Phone:651-815-9250
Practice Address - Fax:651-688-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-16
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2083936310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNFBL2496932132OtherMINNESOTA DEPARTMENT OF HEALTH
MN362964OtherMINNESOTA DEPARTMENT OF HEALTH HOUSING WITH SERVES
MN360103OtherMINNESOTA DEPARTMENT OF HEALTH CLASS F