Healthcare Provider Details

I. General information

NPI: 1144688581
Provider Name (Legal Business Name): ALF PARADISE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2016
Last Update Date: 01/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

866 TAMIAMI TRL UNIT 8
PT CHARLOTTE FL
33953-3103
US

IV. Provider business mailing address

866 TAMIAMI TRL UNIT 8
PT CHARLOTTE FL
33953-3103
US

V. Phone/Fax

Practice location:
  • Phone: 941-249-8787
  • Fax: 941-249-8744
Mailing address:
  • Phone: 941-249-8787
  • Fax: 941-249-8744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9334
License Number StateFL

VIII. Authorized Official

Name: MS. HULDA ROSE GORDON-EHRENPREIS
Title or Position: CEO
Credential: RN
Phone: 941-249-8787