Provider Demographics
NPI:1558147249
Name:MT CASTLE TRANSITIONAL LIVING SERVICES
Entity Type:Organization
Organization Name:MT CASTLE TRANSITIONAL LIVING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-406-2802
Mailing Address - Street 1:3808 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-3031
Mailing Address - Country:US
Mailing Address - Phone:414-406-2802
Mailing Address - Fax:414-540-1066
Practice Address - Street 1:3808 W ELM ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-3031
Practice Address - Country:US
Practice Address - Phone:414-406-2802
Practice Address - Fax:414-540-1066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency