Provider Demographics
NPI:1639629074
Name:CHATEAU BELLE
Entity Type:Organization
Organization Name:CHATEAU BELLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DEMETRI
Authorized Official - Last Name:WINCHESTER
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:909-717-9856
Mailing Address - Street 1:15016 ARROW BLVD
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-3153
Mailing Address - Country:US
Mailing Address - Phone:909-717-9856
Mailing Address - Fax:909-371-0733
Practice Address - Street 1:15016 ARROW BLVD
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-3153
Practice Address - Country:US
Practice Address - Phone:909-717-9856
Practice Address - Fax:909-371-0733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility