Provider Demographics
NPI:1225772452
Name:CASTAWAY ABA LLC
Entity Type:Organization
Organization Name:CASTAWAY ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:CHUDZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:317-518-5126
Mailing Address - Street 1:3104 E MIDLAND RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-4583
Mailing Address - Country:US
Mailing Address - Phone:317-518-5126
Mailing Address - Fax:
Practice Address - Street 1:3104 E MIDLAND RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-4583
Practice Address - Country:US
Practice Address - Phone:317-518-5126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300010638Medicaid
IN300032519Medicaid