Healthcare Provider Details

I. General information

NPI: 1457855355
Provider Name (Legal Business Name): PARADISE LANE ADULT WORKSHOP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 03/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10503 ROCKLEY RD STE 100
HOUSTON TX
77099-3531
US

IV. Provider business mailing address

10503 ROCKLEY RD STE 100
HOUSTON TX
77099-3531
US

V. Phone/Fax

Practice location:
  • Phone: 281-498-1554
  • Fax: 281-529-6740
Mailing address:
  • Phone: 281-498-1554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. RITA OBODECHINA
Title or Position: OWNER
Credential:
Phone: 281-498-1554