Healthcare Provider Details

I. General information

NPI: 1053235036
Provider Name (Legal Business Name): PARADISE LIVING PERSONAL CARE HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 ADDERTON ST
AMERICUS GA
31719-2901
US

IV. Provider business mailing address

619 ADDERTON ST
AMERICUS GA
31719-2901
US

V. Phone/Fax

Practice location:
  • Phone: 229-380-0562
  • Fax: 833-715-3704
Mailing address:
  • Phone: 229-380-0562
  • Fax: 833-715-3704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: YLIESHE WILLIAMS
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 229-563-2482