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General NPI Number Information
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NPI Number | 1033978754
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Entity Type | Organization
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Legal Business Name | GOLDEN YEARS CASTLE KINGS ROW
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Dates
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Enumeration Date | 03/15/2024
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Last Update Date | 03/15/2024
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Provider Practice Location Address
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Address Line | 1875 KINGS ROW
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City | RENO
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State | NV
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Zip | 89503-2249
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Country | US
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Telephone | 775-384-1959
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Fax | 775-384-2922
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Provider Business Mailing Address
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Address Line | 1875 KINGS ROW
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City | RENO
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State | NV
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Zip | 89503-2249
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Country | US
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Telephone | 775-384-1959
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Fax | 775-384-2922
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER CASTILLO
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Credential |
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Telephone | 775-742-9907
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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