Healthcare Provider Details

I. General information

NPI: 1124234174
Provider Name (Legal Business Name): AMANDA'S PARADISE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 01/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6132 SW 129TH CT
MIAMI FL
33183-1238
US

IV. Provider business mailing address

6132 SW 129TH CT
MIAMI FL
33183-1238
US

V. Phone/Fax

Practice location:
  • Phone: 305-386-6695
  • Fax:
Mailing address:
  • Phone: 305-386-6695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number10168
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number10168
License Number StateFL

VIII. Authorized Official

Name: CARMEN R VERA
Title or Position: PRESIDENT
Credential:
Phone: 305-386-6695