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General NPI Number Information
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NPI Number | 1275956088
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Entity Type | Organization
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Legal Business Name | PARADISE REST
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Dates
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Enumeration Date | 01/30/2014
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Last Update Date | 01/30/2014
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Provider Practice Location Address
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Address Line | 1207 30TH AVE E
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City | BRADENTON
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State | FL
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Zip | 34208-4201
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Country | US
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Telephone | 941-746-4761
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Fax | 888-747-9545
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Provider Business Mailing Address
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Address Line | 1207 30TH AVE E
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City | BRADENTON
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State | FL
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Zip | 34208-4201
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Country | US
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Telephone | 941-746-4761
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Fax | 888-747-9545
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. SHERYL RAINEY
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Credential |
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Telephone | 478-234-1860
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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 | AL8065
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License Number State | FL
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