Provider Demographics
NPI:1093988412
Name:CASTLE COUNTRY ASSISTED LIVING, INC.
Entity Type:Organization
Organization Name:CASTLE COUNTRY ASSISTED LIVING, INC.
Other - Org Name:CANTRIL HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:D
Authorized Official - Last Name:DICE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:303-380-1338
Mailing Address - Street 1:255 S VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-2911
Mailing Address - Country:US
Mailing Address - Phone:303-814-0668
Mailing Address - Fax:303-814-0667
Practice Address - Street 1:221 CANTRIL ST
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-2605
Practice Address - Country:US
Practice Address - Phone:303-688-8186
Practice Address - Fax:303-660-2269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04181772Medicaid