Provider Demographics
NPI:1962041798
Name:KIDS' KASTLE GLUCKSTADT
Entity Type:Organization
Organization Name:KIDS' KASTLE GLUCKSTADT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JETUWAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-278-6710
Mailing Address - Street 1:115 AULENBROCK DR STE A
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-7036
Mailing Address - Country:US
Mailing Address - Phone:601-499-0167
Mailing Address - Fax:601-499-0294
Practice Address - Street 1:112 WESTFALEN DRIVE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046
Practice Address - Country:US
Practice Address - Phone:601-499-0167
Practice Address - Fax:601-499-0294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-26
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
No251J00000XAgenciesNursing Care