Provider Demographics
NPI:1497778443
Name:CASTLE FAMILY HEALTH CENTERS INC.
Entity Type:Organization
Organization Name:CASTLE FAMILY HEALTH CENTERS INC.
Other - Org Name:CASTLE FAMILY HEALTH CENTER AT BLOSS
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LUJANO
Authorized Official - Suffix:
Authorized Official - Credentials:DBA
Authorized Official - Phone:209-381-2000
Mailing Address - Street 1:3605 HOSPITAL ROAD
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301
Mailing Address - Country:US
Mailing Address - Phone:209-381-2000
Mailing Address - Fax:209-722-9020
Practice Address - Street 1:1251 GROVE AVENUE
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301
Practice Address - Country:US
Practice Address - Phone:209-381-2000
Practice Address - Fax:209-722-9020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM03997FMedicaid
CA551061Medicare Oscar/Certification