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General NPI Number Information
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NPI Number | 1093217689
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Entity Type | Organization
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Legal Business Name | SANDCASTLE CENTERS LLC
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Dates
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Enumeration Date | 02/28/2018
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Last Update Date | 02/28/2018
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Provider Practice Location Address
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Address Line | 3208 GULF BREEZE PKWY
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City | GULF BREEZE
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State | FL
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Zip | 32563-3350
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Country | US
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Telephone | 850-932-8021
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Fax | 888-958-5753
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Provider Business Mailing Address
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Address Line | 3208 GULF BREEZE PKWY
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City | GULF BREEZE
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State | FL
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Zip | 32563-3350
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Country | US
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Telephone | 850-932-8021
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Fax | 888-958-5753
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Authorized Official
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Title or Position | CEO
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Name | ERICA KINNEBREW
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Credential | MA BCBA
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Telephone | 850-264-1507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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