1568554822 NPI number — CASTLEWOOD TREATMENT CENTER LLC

Table of content: (NPI 1568554822)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568554822 NPI number — CASTLEWOOD TREATMENT CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASTLEWOOD TREATMENT CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
EATING DISORDER CENTER OF MISSOURI
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568554822
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1855 BOWLES AVE STE 210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FENTON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63026-1900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 HOLLAND ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALLWIN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63021-7230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-386-6611
Provider Business Practice Location Address Fax Number:
636-386-6622
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILHELM
Authorized Official First Name:
HEATHER
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF CLIENT ACCOUNTS
Authorized Official Telephone Number:
314-471-5350

Provider Taxonomy Codes

  • Taxonomy code: 323P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 323P00000X , with the licence number: 6423-11579 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 323P00000X , with the licence number: 6818-11581 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 150746 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com