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General NPI Number Information
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NPI Number | 1104172568
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Entity Type | Organization
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Legal Business Name | PARADISE ADULTS CARE
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Dates
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Enumeration Date | 08/02/2012
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Last Update Date | 08/02/2012
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Provider Practice Location Address
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Address Line | 124 ROPEMAKER LN 4 BELVEDERE DRIVE
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City | WILMINGTON ISLAND
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State | GA
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Zip | 31410-2018
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Country | US
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Telephone | 912-335-2991
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 30752
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City | WILMINGTON ISLAND
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State | GA
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Zip | 31410-0752
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Country | US
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Telephone | 912-323-8552
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. JOANNE HARRIGAN
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Credential |
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Telephone | 912-323-8552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 025013271I
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License Number State | GA
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