Provider Demographics
NPI:1467542803
Name:CASTLE RETIREMENT HOME INC
Entity Type:Organization
Organization Name:CASTLE RETIREMENT HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANNIE
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-269-2422
Mailing Address - Street 1:1020 ASH STREET
Mailing Address - Street 2:
Mailing Address - City:WHITEWOOD
Mailing Address - State:SD
Mailing Address - Zip Code:57793
Mailing Address - Country:US
Mailing Address - Phone:605-269-2422
Mailing Address - Fax:
Practice Address - Street 1:1020 ASH STREET
Practice Address - Street 2:
Practice Address - City:WHITEWOOD
Practice Address - State:SD
Practice Address - Zip Code:57793
Practice Address - Country:US
Practice Address - Phone:605-269-2422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10711310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9570760Medicaid