Provider Demographics
NPI:1275072902
Name:SANDCASTLE CARE II LLC
Entity Type:Organization
Organization Name:SANDCASTLE CARE II LLC
Other - Org Name:SANDCASTLE HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-454-4892
Mailing Address - Street 1:PO BOX 90
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32790-0090
Mailing Address - Country:US
Mailing Address - Phone:407-454-4892
Mailing Address - Fax:888-505-2782
Practice Address - Street 1:312 S WOODLAND BLVD
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-5854
Practice Address - Country:US
Practice Address - Phone:386-457-3519
Practice Address - Fax:888-505-2782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-14
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299994610251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020026600Medicaid