Poet's Glade

Primary specialty

Voluntary or Charitable AgencyTaxonomy code 251V00000X

License

32043043572 Issued in TX

Legal business name

POET'S GLADE

Practice address

18065 Rio Hondo Dr
Buena Vista, CO 81211-9126

Phone

(832) 622-3766

NPI assigned

Jun 26, 2011

Last updated

Jun 26, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Donald Christopher Carroll, MDIV

Title

Director

Phone

(832) 622-3766

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1309046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309046400000",
    "number": "1245526458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 875",
            "city": "BUENA VISTA",
            "state": "CO",
            "postal_code": "812110875",
            "telephone_number": "832-622-3766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18065 RIO HONDO DR",
            "city": "BUENA VISTA",
            "state": "CO",
            "postal_code": "812119126",
            "telephone_number": "832-622-3766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POET'S GLADE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-26",
        "last_updated": "2011-06-26",
        "status": "A",
        "authorized_official_last_name": "CARROLL",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "832-622-3766",
        "authorized_official_credential": "MDIV"
    },
    "taxonomies": [
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": "TX",
            "license": "32043043572",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Katie Lynn Provorse

• Voluntary or Charitable Agency in Buena Vista, CO
• Providers in Buena Vista, CO by specialty
• Voluntary or Charitable Agency in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.