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General NPI Number Information
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NPI Number | 1083278675
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Entity Type | Organization
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Legal Business Name | PARADISE OASIS LLC
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Dates
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Enumeration Date | 04/29/2019
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Last Update Date | 05/12/2022
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Provider Practice Location Address
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Address Line | 25 MADISON ST
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City | CHATTAHOOCHEE
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State | FL
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Zip | 32324-1417
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Country | US
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Telephone | 850-354-4166
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Fax |
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Provider Business Mailing Address
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Address Line | 1104 LORRAINE AVE
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City | CHATTAHOOCHEE
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State | FL
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Zip | 32324-1908
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Country | US
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Telephone | 850-272-8576
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Fax |
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Authorized Official
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Title or Position | ADN./MANAGER
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Name | DEBORAH DENICE HUFFMAN-DOUGLAS
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Credential |
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Telephone | 850-272-8576
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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