Provider Demographics
NPI:1326645144
Name:KIDDIE KASTLE INC.
Entity Type:Organization
Organization Name:KIDDIE KASTLE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANI
Authorized Official - Middle Name:
Authorized Official - Last Name:GILFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-413-3010
Mailing Address - Street 1:PO BOX 436
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36702-0436
Mailing Address - Country:US
Mailing Address - Phone:334-875-1045
Mailing Address - Fax:
Practice Address - Street 1:1212 9TH AVE
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36703-4021
Practice Address - Country:US
Practice Address - Phone:334-875-1045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities