Provider Demographics
NPI:1386326478
Name:CASTLEGATE LLC
Entity type:Organization
Organization Name:CASTLEGATE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:RISSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-330-2442
Mailing Address - Street 1:9452 CASTLEGATE DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-5918
Mailing Address - Country:US
Mailing Address - Phone:714-330-2442
Mailing Address - Fax:
Practice Address - Street 1:9452 CASTLEGATE DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-5918
Practice Address - Country:US
Practice Address - Phone:714-330-2442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-07
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness