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General NPI Number Information
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NPI Number | 1205108545
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Entity Type | Organization
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Legal Business Name | PARADISE ASSISTED LIVING
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Dates
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Enumeration Date | 02/02/2012
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Last Update Date | 02/02/2012
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Provider Practice Location Address
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Address Line | 6348 FREDERICK RD
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City | CATONSVILLE
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State | MD
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Zip | 21228-2303
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Country | US
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Telephone | 410-744-8434
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Fax |
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Provider Business Mailing Address
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Address Line | 6348 FREDERICK RD
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City | CATONSVILLE
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State | MD
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Zip | 21228-2303
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GLEN LINDENGREN
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Credential |
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Telephone | 410-744-8434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number | 03AL625-F
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License Number State | MD
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