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General NPI Number Information
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NPI Number | 1538324967
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Entity Type | Organization
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Legal Business Name | HOLLYWOOD PARADISE RESIDENCE INC
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Dates
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Enumeration Date | 07/24/2008
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Last Update Date | 07/24/2008
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Provider Practice Location Address
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Address Line | 1700 N 47TH AVE
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City | HOLLYWOOD
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State | FL
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Zip | 33021-4122
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Country | US
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Telephone | 954-624-5824
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 N 47TH AVE
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City | HOLLYWOOD
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State | FL
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Zip | 33021
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Country | US
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Telephone | 954-624-5824
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LYVIE NOEL
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Credential |
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Telephone | 954-624-5824
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 11323
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License Number State | FL
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