MEDICARE: PARADISE RETREAT ASSISTED LIVING FACILITY 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	261QH0100X	Health Service Clinic/Center	AL12180	FL
2	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1225385214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARADISE RETREAT ASSISTED LIVING FACILITY LLC

Provider Business Mailing Address
First Line	:	5626 SOUTEL DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32219-3772
Country	:	US
Telephone Number	:	904-551-5046
Fax Number	:	904-551-5058

Provider Business Practice Location Address
First Line	:	5626 SOUTEL DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32219-3772
Country	:	US
Telephone Number	:	904-551-5046
Fax Number	:	904-551-5058

Authorized Official
Title or Position	:	OWNER/ ADMINISTRATOR
Name	:	WARRENRINA LA'TARA HENDERSON
Credential	:
Telephone Number	:	904-551-5046

Provider Enumeration Date	:	08/08/2012
Last Update Date	:	08/08/2012

Similar Medicare Providers

1104822923 — KEEPSAFE CENTER, INC.
Practice Location Address:

5626 SOUTEL DR
JACKSONVILLE, FL
32219-3772

Practice Phone: 904-768-6456
Practice Fax: 904-765-0264

1801842679 — SUSAN E. KURNER LCSW
Practice Location Address:

10149 FOX LAKE CT
JACKSONVILLE, FL
32219-1693

Practice Phone: 352-494-6857
Practice Fax: 888-346-3643

1437173697 — BENNIE CLARK JR. DMD
Practice Location Address:

5475 SOUTEL DRIVE
JACKSONVILLE, FL
32219

Practice Phone: 904-764-4576
Practice Fax: 904-766-7021

1710992946 — WALGREEN CO
Practice Location Address:

5340 SOUTEL DR
JACKSONVILLE, FL
32219-3478

Practice Phone: 904-764-1773
Practice Fax:

1669489191 — DR. JANET PAIGE MURRAY MD
Practice Location Address:

9985 PRITCHARD RD , WELLNESS CENTER
JACKSONVILLE, FL
32219-2894

Practice Phone: 904-378-4652
Practice Fax: 904-378-4811

1689871550 — JAMIE CARTER PTA
Practice Location Address:

11738 RAINDROP RD
JACKSONVILLE, FL
32219-5158

Practice Phone: 850-321-1092
Practice Fax:

Directions to “PARADISE RETREAT ASSISTED LIVING FACILITY LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.