Provider Demographics
NPI:1639407505
Name:CHANCELLOR PLACE OF CHINO HILLS
Entity type:Organization
Organization Name:CHANCELLOR PLACE OF CHINO HILLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-606-2553
Mailing Address - Street 1:6500 BUTTERFIELD RANCH RD
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-6379
Mailing Address - Country:US
Mailing Address - Phone:909-606-2553
Mailing Address - Fax:909-606-2744
Practice Address - Street 1:6500 BUTTERFIELD RANCH RD
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-6379
Practice Address - Country:US
Practice Address - Phone:909-606-2553
Practice Address - Fax:909-606-2744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility