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General NPI Number Information
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NPI Number | 1649725144
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Entity Type | Organization
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Legal Business Name | PARADISE VILLA SENIOR CARE,LLC
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Dates
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Enumeration Date | 08/25/2016
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Last Update Date | 08/25/2016
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Provider Practice Location Address
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Address Line | 836 SAN SIMEON DR
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City | CONCORD
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State | CA
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Zip | 94518-2245
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Country | US
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Telephone | 925-446-6651
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Fax |
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Provider Business Mailing Address
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Address Line | 836 SAN SIMEON DR
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City | CONCORD
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State | CA
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Zip | 94518-2245
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Country | US
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Telephone | 925-446-6651
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MS. KONAH JOSEPHINE DOLO
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Credential | RN, BSN, PHN
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Telephone | 704-236-7133
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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 | 079200312
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License Number State | CA
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