Provider Demographics
NPI:1073544334
Name:CASTLE FAMILY HEALTH CENTERS INC.
Entity Type:Organization
Organization Name:CASTLE FAMILY HEALTH CENTERS INC.
Other - Org Name:DAY BREAK ADULT DAY HEALTH CARE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF BUSINESS SERVICES
Authorized Official - Prefix:MISS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-381-2000
Mailing Address - Street 1:3605 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301-5173
Mailing Address - Country:US
Mailing Address - Phone:209-381-2000
Mailing Address - Fax:209-726-0278
Practice Address - Street 1:1251 GROVE AVE
Practice Address - Street 2:SUITE E
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301-3653
Practice Address - Country:US
Practice Address - Phone:209-357-0765
Practice Address - Fax:209-357-2584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070000665261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAADURO420FMedicaid