Provider Demographics
NPI:1720888068
Name:PALM LIFE SUPPORTIVE HOUSING
Entity type:Organization
Organization Name:PALM LIFE SUPPORTIVE HOUSING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSHAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BATTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DHSC, MPH
Authorized Official - Phone:561-701-1215
Mailing Address - Street 1:4449 IXORA CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-4921
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4581 CARTHAGE CIR N
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-7205
Practice Address - Country:US
Practice Address - Phone:561-701-1215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities