Healthcare Provider Details

I. General information

NPI: 1780721019
Provider Name (Legal Business Name): PARADISE HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S MARINE CORP DR STE A2
TAMUNING GU
96913
US

IV. Provider business mailing address

PO BOX 217787
GMF BARRIGADA GU
96921
US

V. Phone/Fax

Practice location:
  • Phone: 671-647-4004
  • Fax: 671-647-4006
Mailing address:
  • Phone: 671-647-4004
  • Fax: 671-647-4006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number706386
License Number StateGU
# 2
Primary TaxonomyY
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number0716774
License Number StateGU

VIII. Authorized Official

Name: MR. BRIAN RICHARD MOYLAN
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 671-647-4004