Provider Demographics
NPI:1649343724
Name:CHATEAU DE SOUTH CORPORATION
Entity type:Organization
Organization Name:CHATEAU DE SOUTH CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:CALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-222-4480
Mailing Address - Street 1:205 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73018-3409
Mailing Address - Country:US
Mailing Address - Phone:405-222-4480
Mailing Address - Fax:405-222-4480
Practice Address - Street 1:205 S 5TH ST
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-3409
Practice Address - Country:US
Practice Address - Phone:405-222-4480
Practice Address - Fax:405-222-4480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKDC2603-2603261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care