Provider Demographics
NPI:1639327463
Name:CASTLES OF LOVE ASSISTED LIVING HOMES, LLC
Entity Type:Organization
Organization Name:CASTLES OF LOVE ASSISTED LIVING HOMES, LLC
Other - Org Name:HARRIS-BRANCH ENTERPRISES, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:HARRIS
Authorized Official - Last Name:BRANCH
Authorized Official - Suffix:
Authorized Official - Credentials:MHS/CNA
Authorized Official - Phone:301-249-4594
Mailing Address - Street 1:15554 PEACH WALKER DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1412
Mailing Address - Country:US
Mailing Address - Phone:301-249-4594
Mailing Address - Fax:301-218-0266
Practice Address - Street 1:14711 MOUNT CALVERT RD
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-9606
Practice Address - Country:US
Practice Address - Phone:301-952-9008
Practice Address - Fax:301-952-7532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16AL178-F310400000X
MD16AL0803-B310400000X
MD16AL0702-C310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD227854503Medicaid
MD227854502Medicaid
MD227854501Medicaid