MEDICARE: CASTLE COUNTRY ASSISTED LIVING,INC.

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	310400000X	Assisted Living Facility	2305HL	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629241047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASTLE COUNTRY ASSISTED LIVING,INC.

Provider Business Mailing Address
First Line	:	255 S VALLEY DR
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-2911
Country	:	US
Telephone Number	:	303-814-0668
Fax Number	:	303-814-0667

Provider Business Practice Location Address
First Line	:	255 S VALLEY DR
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-2911
Country	:	US
Telephone Number	:	303-814-0668
Fax Number	:	303-814-0667

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. BARBARA D DICE
Credential	:	R.N.
Telephone Number	:	303-380-1338

Provider Enumeration Date	:	04/07/2008
Last Update Date	:	04/07/2008

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