Provider Demographics
NPI:1083252571
Name:HALLSTROM CASTLE ASSISTED LIVING
Entity Type:Organization
Organization Name:HALLSTROM CASTLE ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:231-828-4664
Mailing Address - Street 1:PO BOX 5146
Mailing Address - Street 2:
Mailing Address - City:N MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445-0146
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5638 HOLTON RD
Practice Address - Street 2:
Practice Address - City:TWIN LAKE
Practice Address - State:MI
Practice Address - Zip Code:49457-9323
Practice Address - Country:US
Practice Address - Phone:231-828-4664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-15
Last Update Date:2019-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility