Provider Demographics
NPI:1659717635
Name:VAN GOGHS PALETTE INC.
Entity Type:Organization
Organization Name:VAN GOGHS PALETTE INC.
Other - Org Name:VINCENT HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKEEVER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CRC
Authorized Official - Phone:727-541-0359
Mailing Address - Street 1:4801 78TH AVE N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-2436
Mailing Address - Country:US
Mailing Address - Phone:727-541-0359
Mailing Address - Fax:
Practice Address - Street 1:4801 78TH AVE N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-2436
Practice Address - Country:US
Practice Address - Phone:727-541-0359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health