Provider Demographics
NPI:1215943519
Name:CASTLE RIDGE CARE CENTER INC
Entity type:Organization
Organization Name:CASTLE RIDGE CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-631-6450
Mailing Address - Street 1:625 PRAIRIE CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344
Mailing Address - Country:US
Mailing Address - Phone:952-944-8982
Mailing Address - Fax:952-944-6754
Practice Address - Street 1:625 PRAIRIE CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344
Practice Address - Country:US
Practice Address - Phone:952-944-8982
Practice Address - Fax:952-944-6754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
7100364OtherMEDICA
NH0185OtherUCARE
MN255342200Medicaid
9630CAOtherBCBS
240OtherHEALTH PARTNERS
MN255342200Medicaid