Organization
CASTLE COUNTRY CARE CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRAIG R JOHNSON (SEC / TREASURER)
(801) 268-1122
Entity
Organization
Contact information
Practice address
1340 E 300 N, PRICE, UT 84501-2707
(435) 637-9213
(435) 637-4976
Mailing address
PO BOX 57850, MURRAY, UT 84157-0850
(801) 268-1122
(801) 268-1150
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
2005-NCF-32
UT
332BN1400X
Nursing Facility Supplies (DME)
2007-NCF-32
UT
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
2007-NCF-32
UT
Other
Enumeration date
05/22/2006
Last updated
04/20/2008
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