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General NPI Number Information
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NPI Number | 1053331967
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Entity Type | Organization
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Legal Business Name | PARADISE ENTERPRISES LLC
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 01/05/2009
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Provider Practice Location Address
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Address Line | 115 TOWN HILL ROAD SUITE 19
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City | LOUISA
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State | KY
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Zip | 41230
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Country | US
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Telephone | 606-638-0370
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Fax | 606-638-0111
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Provider Business Mailing Address
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Address Line | 100 PARADISE LN
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City | MOREHEAD
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State | KY
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Zip | 40351-7545
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Country | US
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Telephone | 606-638-0370
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Fax | 606-638-0111
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Authorized Official
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Title or Position | OWNER
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Name | MR. JAMES WHITE
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Credential |
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Telephone | 606-638-0370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | P06786
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License Number State | KY
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