Provider Demographics
NPI:1891226262
Name:FRIENDS OF THE CASTLE, INC.
Entity type:Organization
Organization Name:FRIENDS OF THE CASTLE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:937-433-3931
Mailing Address - Street 1:133 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4620
Mailing Address - Country:US
Mailing Address - Phone:937-433-3931
Mailing Address - Fax:937-434-7678
Practice Address - Street 1:133 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4620
Practice Address - Country:US
Practice Address - Phone:937-433-3931
Practice Address - Fax:937-434-7678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH01-0417251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health