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General NPI Number Information
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NPI Number | 1033352760
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Entity Type | Organization
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Legal Business Name | MOUNT CASTLE CORPORATION
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Dates
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Enumeration Date | 04/10/2009
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Last Update Date | 04/10/2009
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Provider Practice Location Address
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Address Line | 3808 W ELM ST
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City | MILWAUKEE
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State | WI
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Zip | 53209-3031
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Country | US
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Telephone | 414-540-6479
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Fax | 414-540-6993
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Provider Business Mailing Address
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Address Line | 3808 W ELM ST
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City | MILWAUKEE
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State | WI
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Zip | 53209-3031
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Country | US
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Telephone | 414-540-6479
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Fax | 414-540-6993
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MR. WENDY BOND
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Credential |
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Telephone | 414-540-6479
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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