MEDICARE: MT CASTLE TRANSITIONAL LIVING SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253J00000X	Foster Care Agency

General Provider Information

NPI Number	:	1558147249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MT CASTLE TRANSITIONAL LIVING SERVICES

Provider Business Mailing Address
First Line	:	3808 W ELM ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-3031
Country	:	US
Telephone Number	:	414-406-2802
Fax Number	:	414-540-1066

Provider Business Practice Location Address
First Line	:	3808 W ELM ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-3031
Country	:	US
Telephone Number	:	414-406-2802
Fax Number	:	414-540-1066

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. MICHAEL HARPER
Credential	:
Telephone Number	:	414-406-2802

Provider Enumeration Date	:	09/07/2023
Last Update Date	:	09/07/2023

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