Provider Demographics
NPI:1902539521
Name:CHALATI GROUP LLC
Entity Type:Organization
Organization Name:CHALATI GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NOUR
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHALATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-254-9666
Mailing Address - Street 1:2175 CONDOR DR UNIT 48
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-2904
Mailing Address - Country:US
Mailing Address - Phone:619-254-9666
Mailing Address - Fax:
Practice Address - Street 1:2175 CONDOR DR UNIT 48
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915-2904
Practice Address - Country:US
Practice Address - Phone:619-254-9666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care