| Organization Name: | CASTLE HOME MODIFICATION LLC |
| NPI Number: | 1770949133 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRENDA CASTLE (MEMBER) |
| Mailing Address: | 102 S Main St Convoy |
| State: | OH US |
| Postal Code: | 458327710 |
| Phone Number: | 4197492022 |
| Fax Number: | 4197492022 |
| NPI Enumeration Date: | 01/14/2016 |
| NPI Last Update Date: | 01/14/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171WH0202X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Contractor |
| Taxonomy Specialization: | Home Modifications |
| Taxonomy Definition: | |