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General NPI Number Information
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NPI Number | 1679055602
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Entity Type | Organization
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Legal Business Name | ROME'S PARADISE ASSISTED LIVING LLC
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Dates
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Enumeration Date | 09/06/2018
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Last Update Date | 09/06/2018
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Provider Practice Location Address
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Address Line | 226 ABALONE RD NW
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City | PALM BAY
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State | FL
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Zip | 32907-2964
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Country | US
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Telephone | 321-473-8083
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Fax |
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Provider Business Mailing Address
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Address Line | 304 HANFORD RD SW
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City | PALM BAY
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State | FL
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Zip | 32908-1200
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TARA D JOHNSON
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Credential |
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Telephone | 321-480-4052
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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 |
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License Number State |
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