MEDICARE: CASTLE GROVE PROPERTIES

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	311ZA0620X	Adult Care Home Facility	B044003	KS

General Provider Information

NPI Number	:	1922248046
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASTLE GROVE PROPERTIES

Provider Business Mailing Address
First Line	:	1509 LINN ST
Second Line	:
City	:	VALLEY FALLS
State	:	KS
Zip	:	66088-1185
Country	:	US
Telephone Number	:	785-945-3634
Fax Number	:	785-945-3682

Provider Business Practice Location Address
First Line	:	1509 LINN ST
Second Line	:
City	:	VALLEY FALLS
State	:	KS
Zip	:	66088-1185
Country	:	US
Telephone Number	:	785-945-3634
Fax Number	:	785-945-3682

Authorized Official
Title or Position	:	OPERATOR/GENERAL MANAGER
Name	:	LAURA MICHELLE RICH-FORBES
Credential	:
Telephone Number	:	785-250-0313

Provider Enumeration Date	:	03/02/2009
Last Update Date	:	03/25/2009

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Directions to “CASTLE GROVE PROPERTIES ” Practice Location

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