Healthcare Provider Details

I. General information

NPI: 1972445476
Provider Name (Legal Business Name): JIBRIL IMAN TINSLEY MCCASTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JIBRIL MCCASTER

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1522 WATERFALL WAY
ELSMERE KY
41018-4023
US

IV. Provider business mailing address

1522 WATERFALL WAY
ELSMERE KY
41018-4023
US

V. Phone/Fax

Practice location:
  • Phone: 859-907-7443
  • Fax:
Mailing address:
  • Phone: 859-907-7443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: