Healthcare Provider Details

I. General information

NPI: 1700679693
Provider Name (Legal Business Name): ASHLEY'S PINK PARADISE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2025
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10226 SHAWNEE BLF
CONVERSE TX
78109-2335
US

IV. Provider business mailing address

10226 SHAWNEE BLF
CONVERSE TX
78109-2335
US

V. Phone/Fax

Practice location:
  • Phone: 210-915-2616
  • Fax: 800-489-8055
Mailing address:
  • Phone: 210-915-2616
  • Fax: 800-489-8055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY NICOLE JONES
Title or Position: OWNER/CEO
Credential:
Phone: 210-915-2616