Provider Demographics
NPI:1265467948
Name:CASTLE FAMILY HEALTH CENTER & ADULT DAYCARE
Entity Type:Organization
Organization Name:CASTLE FAMILY HEALTH CENTER & ADULT DAYCARE
Other - Org Name:CASTLE LABORATORY
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:SUITE H
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 1:3605 HOSPITAL RD
Practice Address - Street 2:SUITE H
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301-5173
Practice Address - Country:US
Practice Address - Phone:209-381-2000
Practice Address - Fax:209-726-0278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ14575ZMedicare PIN