Provider Demographics
NPI:1902928419
Name:SYBIL M CASTLE
Entity Type:Organization
Organization Name:SYBIL M CASTLE
Other - Org Name:ADVENTURE HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOROWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SYBIL
Authorized Official - Middle Name:M
Authorized Official - Last Name:CASTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-596-0403
Mailing Address - Street 1:1003 GLENROSE DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-2646
Mailing Address - Country:US
Mailing Address - Phone:919-596-0403
Mailing Address - Fax:919-598-0940
Practice Address - Street 1:4 KIMBROUGH CT
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-2919
Practice Address - Country:US
Practice Address - Phone:919-957-9097
Practice Address - Fax:919-598-0940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC032347320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805777Medicaid