Healthcare Provider Details

I. General information

NPI: 1124573027
Provider Name (Legal Business Name): ROYAL PARADISE GROUP HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2016
Last Update Date: 08/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5496 COCONUT BLVD
WEST PALM BEACH FL
33411-8542
US

IV. Provider business mailing address

136 GRANADA ST
ROYAL PALM BEACH FL
33411-1307
US

V. Phone/Fax

Practice location:
  • Phone: 561-305-7268
  • Fax: 561-508-7494
Mailing address:
  • Phone: 561-305-7268
  • Fax: 561-508-7494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: SHIRLEY BRYCE
Title or Position: DIRECTOR
Credential:
Phone: 561-305-7268