1699119578 NPI number — CHATEAU RECOVERY CENTER

Table of content: (NPI 1699119578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699119578 NPI number — CHATEAU RECOVERY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHATEAU RECOVERY CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ALPINE TREATMENT SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699119578
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDWAY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-654-1642
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
375 RAINBOW LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDWAY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84049-7001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-654-1642
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/23/2013

Additional Information

Authorized Official

Authorized Official Last Name:
WARNER
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
354-654-1082

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 323P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , with the licence number: 20095 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DT-77237 . This is a "UTAH OFFICE OF LICENSING" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: RT-52330 . This is a "UTAH OFFICE OF LICENSING" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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