Healthcare Provider Details

I. General information

NPI: 1669678082
Provider Name (Legal Business Name): PARADISE MANOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 E. LINCOLN AVE
HATFIELD PA
19440
US

IV. Provider business mailing address

206 E LINCOLN AVE
HATFIELD PA
19440-2541
US

V. Phone/Fax

Practice location:
  • Phone: 215-855-2697
  • Fax:
Mailing address:
  • Phone: 215-855-2697
  • Fax: 215-855-2832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberA40280
License Number StatePA

VIII. Authorized Official

Name: MR. LEOCADIO V CHUA
Title or Position: ADMINISTRATOR
Credential: REV.
Phone: 215-855-2697