Provider Demographics
NPI:1588637342
Name:ROCKCASTLE HEALTH AND REHABILITATION CENTER, INC.
Entity Type:Organization
Organization Name:ROCKCASTLE HEALTH AND REHABILITATION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-256-2195
Mailing Address - Street 1:371 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BRODHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40409-9701
Mailing Address - Country:US
Mailing Address - Phone:606-758-8711
Mailing Address - Fax:
Practice Address - Street 1:371 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:BRODHEAD
Practice Address - State:KY
Practice Address - Zip Code:40409-9701
Practice Address - Country:US
Practice Address - Phone:606-758-8711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100375314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12501037Medicaid
KY0641200001OtherDME
KY000000054638OtherBLUE CROSS BLUE SHIELD
KY12501037Medicaid