Healthcare Provider Details

I. General information

NPI: 1407025406
Provider Name (Legal Business Name): CASTLE HEALTHCARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 FAYETTEVILLE RD
DURHAM NC
27713-9754
US

IV. Provider business mailing address

12108 RANLEIGH CT
RALEIGH NC
27613-5525
US

V. Phone/Fax

Practice location:
  • Phone: 919-544-9021
  • Fax:
Mailing address:
  • Phone: 919-332-9547
  • Fax: 919-846-6625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARLYN C TEAGUE
Title or Position: NURSE PRACTITIONER
Credential:
Phone: 919-332-9547