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General NPI Number Information
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NPI Number | 1134940976
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Entity Type | Organization
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Legal Business Name | SANDCASTLE RECOVERY LLC
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Dates
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Enumeration Date | 10/23/2024
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 321 WILDWOOD CIR
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City | ROBERTS
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State | WI
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Zip | 54023-8634
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Country | US
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Telephone | 715-410-6530
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Fax |
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Provider Business Mailing Address
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Address Line | 300 N PARK ST # 1
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City | ROBERTS
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State | WI
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Zip | 54023-9782
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Country | US
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Telephone | 715-220-3042
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Fax |
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Authorized Official
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Title or Position | SUBSTANCE ABUSE COUNSELOR
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Name | JAIMIE MICHELLE ALTHOFF
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Credential | CSAC, LADC
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Telephone | 715-410-6530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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