Healthcare Provider Details

I. General information

NPI: 1194351924
Provider Name (Legal Business Name): PARADISE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2020
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 LABRADOR LN
JEFFERSON HLS PA
15025-5239
US

IV. Provider business mailing address

422 LABRADOR LN
JEFFERSON HLS PA
15025-5239
US

V. Phone/Fax

Practice location:
  • Phone: 510-689-4140
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JIWAN PRADHAN
Title or Position: VICE PRESIDENT
Credential:
Phone: 336-689-4140