Provider Demographics
NPI:1467167809
Name:CHILDRENS PALACE CARE SERVICES
Entity Type:Organization
Organization Name:CHILDRENS PALACE CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-879-8370
Mailing Address - Street 1:8965 N BROADWAY ST APT 3108
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77034-3015
Mailing Address - Country:US
Mailing Address - Phone:832-879-8370
Mailing Address - Fax:
Practice Address - Street 1:8965 N BROADWAY ST APT 3108
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034-3015
Practice Address - Country:US
Practice Address - Phone:832-879-8370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-19
Last Update Date:2023-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty