| Organization Name: | POET'S GLADE |
| NPI Number: | 1245526458 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DONALD CHRISTOPHER CARROLL (DIRECTOR) |
| Mailing Address: | 18065 Rio Hondo Dr Buena Vista |
| State: | CO US |
| Postal Code: | 812119126 |
| Phone Number: | 8326223766 |
| Fax Number: | |
| NPI Enumeration Date: | 06/26/2011 |
| NPI Last Update Date: | 06/26/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251V00000X |
| License Number: | 32043043572 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Voluntary or Charitable |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |