Provider Demographics
NPI:1023091840
Name:CASTLE REST NURSING HOME
Entity type:Organization
Organization Name:CASTLE REST NURSING HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:
Authorized Official - Last Name:OTOOLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:315-475-1641
Mailing Address - Street 1:116 E CASTLE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205-1110
Mailing Address - Country:US
Mailing Address - Phone:315-475-1641
Mailing Address - Fax:315-478-0688
Practice Address - Street 1:116 E CASTLE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205-1110
Practice Address - Country:US
Practice Address - Phone:315-475-1641
Practice Address - Fax:315-478-0688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-25
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3301326N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01992130Medicaid
NY00474415Medicaid
NY01992130Medicaid
NY811430AMedicare Oscar/Certification