Healthcare Provider Details

I. General information

NPI: 1710295415
Provider Name (Legal Business Name): PARADISE ISD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 09/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 SCHOOL HOUSE RD
PARADISE TX
76073-2619
US

IV. Provider business mailing address

338 SCHOOL HOUSE RD
PARADISE TX
76073-2619
US

V. Phone/Fax

Practice location:
  • Phone: 940-683-8361
  • Fax: 940-683-5849
Mailing address:
  • Phone: 940-683-8361
  • Fax: 940-683-5849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: PAM JONES
Title or Position: BOOKKEEPER
Credential:
Phone: 940-683-8361