=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386781995
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARADISE HEALTHCARE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2810 SPRING RD SE STE 112
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30339-3066
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-434-1900
-----------------------------------------------------
Fax | 770-434-1992
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2810 SPRING RD SE STE 112
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30339-3066
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-434-1900
-----------------------------------------------------
Fax | 770-434-1992
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. TONY EHIMEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 770-434-1900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 033-R-0090
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------