Provider Demographics
NPI:1558829622
Name:CHATEAU TRANSPORTATION, LLC
Entity Type:Organization
Organization Name:CHATEAU TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:EDS
Authorized Official - Phone:601-651-2340
Mailing Address - Street 1:PO BOX 1132
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39441-1132
Mailing Address - Country:US
Mailing Address - Phone:601-651-2340
Mailing Address - Fax:601-340-3131
Practice Address - Street 1:3712 HIGHWAY 15 N
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-1447
Practice Address - Country:US
Practice Address - Phone:601-651-2340
Practice Address - Fax:601-340-3131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)