Healthcare Provider Details

I. General information

NPI: 1821317041
Provider Name (Legal Business Name): CASTLE MANOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 09/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 CASTLE MANOR DR
LINCOLN IL
62656-6000
US

IV. Provider business mailing address

115 W JEFFERSON ST STE 401
BLOOMINGTON IL
61701-3967
US

V. Phone/Fax

Practice location:
  • Phone: 217-732-2310
  • Fax: 217-732-2359
Mailing address:
  • Phone: 309-823-7155
  • Fax: 309-829-9512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. CRAIG L ATER
Title or Position: EXEC VP & CFO
Credential:
Phone: 309-823-7135