Provider Demographics
NPI:1992317762
Name:CASTLE SENIOR LIVING, INC
Entity type:Organization
Organization Name:CASTLE SENIOR LIVING, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-225-3019
Mailing Address - Street 1:10427 W LINCOLN AVE STE 1400
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-1263
Mailing Address - Country:US
Mailing Address - Phone:414-930-4432
Mailing Address - Fax:262-977-7746
Practice Address - Street 1:10427 W LINCOLN AVE STE 1400
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-1263
Practice Address - Country:US
Practice Address - Phone:414-930-4432
Practice Address - Fax:262-977-7746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-21
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2055OtherPROVISIONAL LICENSE