Provider Demographics
NPI:1770641656
Name:THE CHALET HOUSE LLC
Entity Type:Organization
Organization Name:THE CHALET HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GISELE
Authorized Official - Middle Name:
Authorized Official - Last Name:NZEUKOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-777-4908
Mailing Address - Street 1:8855 E CALLE BOGOTA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-5524
Mailing Address - Country:US
Mailing Address - Phone:520-777-4908
Mailing Address - Fax:520-495-0125
Practice Address - Street 1:8855 E CALLE BOGOTA
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-5524
Practice Address - Country:US
Practice Address - Phone:529-777-4908
Practice Address - Fax:520-495-0125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH2817320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness