MEDICARE: CSTL, 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	177F00000X	Lodging Provider

General Provider Information

NPI Number	:	1982883831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CSTL, INC.

Provider Business Mailing Address
First Line	:	8938 MADISON AVE
Second Line	:
City	:	FAIR OAKS
State	:	CA
Zip	:	95628-4010
Country	:	US
Telephone Number	:	916-961-2691
Fax Number	:

Provider Business Practice Location Address
First Line	:	8938 MADISON AVE
Second Line	:
City	:	FAIR OAKS
State	:	CA
Zip	:	95628-4010
Country	:	US
Telephone Number	:	916-961-2691
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. DONALD TROUTMAN
Credential	:	CAS II, CRPM
Telephone Number	:	916-961-2691

Provider Enumeration Date	:	10/29/2007
Last Update Date	:	10/29/2007

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Directions to “CSTL, INC. ” Practice Location

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