Provider Demographics
NPI:1134940976
Name:SANDCASTLE RECOVERY LLC
Entity type:Organization
Organization Name:SANDCASTLE RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUBSTANCE ABUSE COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JAIMIE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:ALTHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:CSAC, LADC
Authorized Official - Phone:715-410-6530
Mailing Address - Street 1:300 N PARK ST # 1
Mailing Address - Street 2:
Mailing Address - City:ROBERTS
Mailing Address - State:WI
Mailing Address - Zip Code:54023-9782
Mailing Address - Country:US
Mailing Address - Phone:715-220-3042
Mailing Address - Fax:
Practice Address - Street 1:321 WILDWOOD CIR
Practice Address - Street 2:
Practice Address - City:ROBERTS
Practice Address - State:WI
Practice Address - Zip Code:54023-8634
Practice Address - Country:US
Practice Address - Phone:715-410-6530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder