Organization
LUCILLE'S PALACE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DARA JAMES (ADMINISTRATOR)
(817) 403-8465
Entity
Organization
Contact information
Practice address
3361 HARMON RD UNIT 2110, MANSFIELD, TX 76063-5764
(817) 403-8465
Mailing address
3361 HARMON RD UNIT 2110, MANSFIELD, TX 76063-5764
(817) 403-8465
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
02/13/2020
Last updated
06/05/2023
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