Healthcare Provider Details

I. General information

NPI: 1093217689
Provider Name (Legal Business Name): SANDCASTLE CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 02/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3208 GULF BREEZE PKWY
GULF BREEZE FL
32563-3350
US

IV. Provider business mailing address

3208 GULF BREEZE PKWY
GULF BREEZE FL
32563-3350
US

V. Phone/Fax

Practice location:
  • Phone: 850-932-8021
  • Fax: 888-958-5753
Mailing address:
  • Phone: 850-932-8021
  • Fax: 888-958-5753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: ERICA KINNEBREW
Title or Position: CEO
Credential: MA BCBA
Phone: 850-264-1507