Provider Demographics
NPI:1568554822
Name:CASTLEWOOD TREATMENT CENTER LLC
Entity Type:Organization
Organization Name:CASTLEWOOD TREATMENT CENTER LLC
Other - Org Name:EATING DISORDER CENTER OF MISSOURI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CLIENT ACCOUNTS
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:WILHELM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-471-5350
Mailing Address - Street 1:1855 BOWLES AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-1900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 HOLLAND ROAD
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63021-7230
Practice Address - Country:US
Practice Address - Phone:636-386-6611
Practice Address - Fax:636-386-6622
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TREATMENT CENTER ACQUISITION COMPANY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-28
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
323P00000X
MO6423-11579323P00000X
MO6818-11581323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
150746OtherBLUE CROSS BLUE SHIELD