Provider Demographics
NPI:1790565950
Name:PAINTED HALOS LLC
Entity Type:Organization
Organization Name:PAINTED HALOS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERI
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLSEBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-437-0312
Mailing Address - Street 1:3615 W PIONEER PKWY STE E
Mailing Address - Street 2:
Mailing Address - City:PANTEGO
Mailing Address - State:TX
Mailing Address - Zip Code:76013-4518
Mailing Address - Country:US
Mailing Address - Phone:817-437-0312
Mailing Address - Fax:
Practice Address - Street 1:3615 W PIONEER PKWY STE E
Practice Address - Street 2:
Practice Address - City:PANTEGO
Practice Address - State:TX
Practice Address - Zip Code:76013-4518
Practice Address - Country:US
Practice Address - Phone:817-437-0312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty