MEDICARE: CASTLE PINES HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1023643806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASTLE PINES HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	1020 PATTON ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4018
Country	:	US
Telephone Number	:	970-484-7981
Fax Number	:	970-484-8143

Provider Business Practice Location Address
First Line	:	1020 PATTON ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4018
Country	:	US
Telephone Number	:	970-484-7981
Fax Number	:	970-484-8143

Authorized Official
Title or Position	:	TREASURER
Name	:	SOON BURNAM
Credential	:
Telephone Number	:	959-540-1249

Provider Enumeration Date	:	03/11/2020
Last Update Date	:	07/05/2023

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