MEDICARE: MASTERPIECE MANOR LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1083569065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MASTERPIECE MANOR LLC

Provider Business Mailing Address
First Line	:	3041 CASA BELLA DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76010-3707
Country	:	US
Telephone Number	:	859-691-0943
Fax Number	:

Provider Business Practice Location Address
First Line	:	3041 CASA BELLA DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76010-3707
Country	:	US
Telephone Number	:	859-691-0943
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KAYLA SHACOLE GLOVER
Credential	:
Telephone Number	:	859-691-0943

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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Directions to “MASTERPIECE MANOR LLC ” Practice Location

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