Provider Demographics
NPI:1326360769
Name:CASTLE ROCK SENIOR LIVING, LLC
Entity Type:Organization
Organization Name:CASTLE ROCK SENIOR LIVING, LLC
Other - Org Name:CASTLE ROCK CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NHA DIRECTOR OF COLORADO OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:LAFONT
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:303-688-3174
Mailing Address - Street 1:4001 HOME STREET
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-9495
Mailing Address - Country:US
Mailing Address - Phone:303-688-3174
Mailing Address - Fax:303-688-8051
Practice Address - Street 1:4001 HOME STREET
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-9495
Practice Address - Country:US
Practice Address - Phone:303-688-3174
Practice Address - Fax:303-688-8051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-26
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
310400000X
CO020591314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05259525Medicaid
065285Medicare PIN