1639327463 NPI number — CASTLES OF LOVE ASSISTED LIVING HOMES, LLC

Table of content: (NPI 1639327463)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639327463 NPI number — CASTLES OF LOVE ASSISTED LIVING HOMES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASTLES OF LOVE ASSISTED LIVING HOMES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HARRIS-BRANCH ENTERPRISES, INC.
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639327463
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15554 PEACH WALKER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOWIE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20716-1412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-249-4594
Provider Business Mailing Address Fax Number:
301-218-0266

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14711 MOUNT CALVERT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UPPER MARLBORO
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20772-9606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-952-9008
Provider Business Practice Location Address Fax Number:
301-952-7532
Provider Enumeration Date:
09/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BRANCH
Authorized Official First Name:
CHARLOTTE
Authorized Official Middle Name:
HARRIS
Authorized Official Title or Position:
PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
301-249-4594

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  16AL178-F , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 310400000X , with the licence number: 16AL0803-B , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 310400000X , with the licence number: 16AL0702-C , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 227854503 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 227854502 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 227854501 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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