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General NPI Number Information
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NPI Number | 1568231033
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Entity Type | Organization
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Legal Business Name | SENIOR PARADISE LLC
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Dates
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Enumeration Date | 12/26/2023
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Last Update Date | 12/26/2023
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Provider Practice Location Address
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Address Line | 3650 SW VICEROY ST
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City | PORT ST LUCIE
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State | FL
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Zip | 34953-3733
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Country | US
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Telephone | 772-722-0477
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Fax |
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Provider Business Mailing Address
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Address Line | 3650 SW VICEROY ST
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City | PORT ST LUCIE
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State | FL
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Zip | 34953-3733
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Country | US
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Telephone | 772-722-0477
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. GARON LINDO
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Credential | CNA
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Telephone | 772-722-4077
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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 |
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License Number State |
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