Provider Demographics
NPI:1093217689
Name:SANDCASTLE CENTERS LLC
Entity Type:Organization
Organization Name:SANDCASTLE CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:KINNEBREW
Authorized Official - Suffix:
Authorized Official - Credentials:MA BCBA
Authorized Official - Phone:850-264-1507
Mailing Address - Street 1:3208 GULF BREEZE PKWY
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-3350
Mailing Address - Country:US
Mailing Address - Phone:850-932-8021
Mailing Address - Fax:888-958-5753
Practice Address - Street 1:3208 GULF BREEZE PKWY
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-3350
Practice Address - Country:US
Practice Address - Phone:850-932-8021
Practice Address - Fax:888-958-5753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty