Basic Information
| Provider Information | |||||||||
| NPI: | 1548336415 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CASTLE NURSING HOMES, INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | WATCH HILL PHARMACY, LTD. | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 434 N WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | MILLERSBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446541188 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306740015 | ||||||||
| FaxNumber: | 3306744914 | ||||||||
| Practice Location | |||||||||
| Address1: | 434 N WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | MILLERSBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446541188 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306740015 | ||||||||
| FaxNumber: | 3307632206 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ROCHELLE | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | V. P. FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 3306740015 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336L0003X | OH | Y | Suppliers | Pharmacy | Long Term Care Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 2118550 | 05 | OH | MEDICAID |