Provider Demographics
NPI:1700225463
Name:HOUSE OF PRINCIPLES
Entity Type:Organization
Organization Name:HOUSE OF PRINCIPLES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:IACULLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-715-9288
Mailing Address - Street 1:3208 S DIXIE HWY APT 1
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33405-1550
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3208 S DIXIE HWY APT 1
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33405-1550
Practice Address - Country:US
Practice Address - Phone:561-308-2685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility