Provider Demographics
NPI:1184627531
Name:THE CHALON CORPORATION
Entity type:Organization
Organization Name:THE CHALON CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN AMBURGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-771-0999
Mailing Address - Street 1:PO BOX 2500
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-9000
Mailing Address - Country:US
Mailing Address - Phone:972-771-0999
Mailing Address - Fax:972-771-2281
Practice Address - Street 1:930 W RALPH HALL PKWY
Practice Address - Street 2:#120
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6664
Practice Address - Country:US
Practice Address - Phone:972-771-1090
Practice Address - Fax:972-771-6543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX553130001225X00000X
TX612140000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165348701Medicaid
TX456643Medicare Oscar/Certification