Healthcare Provider Details

I. General information

NPI: 1275297681
Provider Name (Legal Business Name): PARADISE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2021
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 E MCDOWELL RD STE 412
PHOENIX AZ
85008-4448
US

IV. Provider business mailing address

4040 E MCDOWELL RD STE 412
PHOENIX AZ
85008-4448
US

V. Phone/Fax

Practice location:
  • Phone: 602-410-9871
  • Fax:
Mailing address:
  • Phone: 602-410-9871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: DIRIBA FEYISSA
Title or Position: MANAGER
Credential:
Phone: 602-410-9871