Organization
PALACE 1 THERAPEUTIC RANCH
Active
Parent organization
PALACE 1 ART DAY HAB
Other names
Palace 1 Art Day Hab
Organization subpart
Yes
Provider details
NPI number
Legal business name
PALACE 1 ART DAY HAB
Authorized official
MS. VIRGINIA IRENE WOOTEN-RUSH (CEO/OWNER)
(469) 235-5443
Entity
Organization
Contact information
Practice address
2115 MESA WOOD DR, GLENN HEIGHTS, TX 75154-8583
(469) 235-5443
Mailing address
PO BOX 2862, DESOTO, TX 75123-2862
(469) 235-5443
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
32072801361
TAXPAYER NUMBER
TX
Enumeration date
09/13/2022
Last updated
09/13/2022
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