Provider Demographics
NPI:1629783444
Name:HOUSE OF PALM WELLNESS LLC
Entity Type:Organization
Organization Name:HOUSE OF PALM WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:THRENUR
Authorized Official - Middle Name:VELEZIA
Authorized Official - Last Name:HOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-780-0732
Mailing Address - Street 1:730 ROUTE 304 STE 11
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-2842
Mailing Address - Country:US
Mailing Address - Phone:347-780-0732
Mailing Address - Fax:
Practice Address - Street 1:730 ROUTE 304 STE 11
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-2842
Practice Address - Country:US
Practice Address - Phone:347-780-0732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-16
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty