Lucille'S Palace, LLC
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Mansfield, TX. Organization (NPI-2).
NPI number1851924203
StatusActive
Last updated in NPPESJun 5, 2023
Details
- NPI
- 1851924203
- Entity type
- Organization (NPI-2)
- Legal business name
- Lucille'S Palace, LLC
- Organization subpart
- No
- Enumeration date
- Feb 13, 2020
- Certification date
- Jun 5, 2023
- Last updated
- Jun 5, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 320900000X | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | – | – | Yes |
| 320600000X | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | – | – |
Practice location
3361 Harmon Rd Unit 2110Mansfield, TX 76063-5764
Phone 817-403-8465
Mailing address
3361 Harmon Rd Unit 2110Mansfield, TX 76063-5764
Phone 817-403-8465
Authorized official
Dara James
Administrator
8174038465
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