Provider Demographics
NPI:1598948465
Name:THE POTTER'S PALACE ASSISTED GROUP HOMES
Entity Type:Organization
Organization Name:THE POTTER'S PALACE ASSISTED GROUP HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-375-7700
Mailing Address - Street 1:2720 E ATOLL DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-3208
Mailing Address - Country:US
Mailing Address - Phone:214-375-7700
Mailing Address - Fax:214-375-8848
Practice Address - Street 1:2720 E ATOLL DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-3208
Practice Address - Country:US
Practice Address - Phone:214-375-7700
Practice Address - Fax:214-375-8848
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE POTTER'S PALACE ASSISTED GROUP HOMES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility