Provider Demographics
NPI:1336578343
Name:JOLI CHATEAU, INC.
Entity Type:Organization
Organization Name:JOLI CHATEAU, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVADNEY
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:WALKER-AVOINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-224-4064
Mailing Address - Street 1:201 22ND STREET CT NE
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1756
Mailing Address - Country:US
Mailing Address - Phone:941-224-4064
Mailing Address - Fax:941-749-8540
Practice Address - Street 1:201 22ND STREET CT NE
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1756
Practice Address - Country:US
Practice Address - Phone:941-224-4064
Practice Address - Fax:941-749-8540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-11
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL233212253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009305100Medicaid