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General NPI Number Information
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NPI Number | 1720888068
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Entity Type | Organization
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Legal Business Name | PALM LIFE SUPPORTIVE HOUSING
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Dates
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Enumeration Date | 03/17/2025
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 4581 CARTHAGE CIR N
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City | LAKE WORTH
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State | FL
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Zip | 33463-7205
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Country | US
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Telephone | 561-701-1215
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Fax |
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Provider Business Mailing Address
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Address Line | 4449 IXORA CIR
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City | LAKE WORTH
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State | FL
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Zip | 33461-4921
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROSHAYLA BATTLE
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Credential | DHSC, MPH
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Telephone | 561-701-1215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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