Provider Demographics
NPI:1679254049
Name:PALACE 1ART DAY HAB
Entity Type:Organization
Organization Name:PALACE 1ART DAY HAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:WOOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-235-5443
Mailing Address - Street 1:2115 MESA WOOD DR
Mailing Address - Street 2:
Mailing Address - City:GLENN HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:75154-8583
Mailing Address - Country:US
Mailing Address - Phone:469-235-5443
Mailing Address - Fax:
Practice Address - Street 1:2115 MESA WOOD DR
Practice Address - Street 2:
Practice Address - City:GLENN HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:75154-8583
Practice Address - Country:US
Practice Address - Phone:469-235-5443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PALACE 1 THERAPEUTIC RANCH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No102X00000XBehavioral Health & Social Service ProvidersPoetry TherapistGroup - Multi-Specialty