Individual
CHANTALLAN BAZILE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
310 N BROAD ST # 309, ELIZABETH, NJ 07208-3705
(862) 389-9079
Mailing address
310 N BROAD ST # 309, ELIZABETH, NJ 07208-3705
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
253J00000X
Foster Care Agency
—
—
311ZA0620X
Adult Care Home Facility
—
—
Other
Enumeration date
01/10/2025
Last updated
01/10/2025
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