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General NPI Number Information
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NPI Number | 1467626416
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Entity Type | Organization
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Legal Business Name | PARADISE ELDERLY HOME, CORP
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Dates
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Enumeration Date | 04/21/2008
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Last Update Date | 04/21/2008
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Provider Practice Location Address
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Address Line | 12690 NE 2ND AVE
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City | NORTH MIAMI
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State | FL
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Zip | 33161-4556
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Country | US
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Telephone | 305-926-1193
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Fax |
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Provider Business Mailing Address
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Address Line | 12690 NE 2ND AVE
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City | NORTH MIAMI
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State | FL
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Zip | 33161-4556
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Country | US
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Telephone | 305-926-1193
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | YENISLEIDY RIOS
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Credential |
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Telephone | 305-926-1193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 11278
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License Number State | FL
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