Provider Demographics
NPI:1417564691
Name:SANDCASTLE CARE V LLC
Entity type:Organization
Organization Name:SANDCASTLE CARE V LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-454-4892
Mailing Address - Street 1:PO BOX 90
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32790-0090
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:888-505-2782
Practice Address - Street 1:13940 N US HIGHWAY 441 STE 903
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-8954
Practice Address - Country:US
Practice Address - Phone:527-720-0113
Practice Address - Fax:888-505-2782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-30
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112246900Medicaid