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General NPI Number Information
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NPI Number | 1790027027
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Entity Type | Organization
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Legal Business Name | PARADISE HILL HOME ASSISTED LIVING FACILITY
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Dates
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Enumeration Date | 03/25/2013
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Last Update Date | 03/25/2013
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Provider Practice Location Address
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Address Line | 1682 LARA ST NE
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City | PALM BAY
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State | FL
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Zip | 32907-2421
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Country | US
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Telephone | 321-327-4153
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Fax |
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Provider Business Mailing Address
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Address Line | 1682 LARA ST NE
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City | PALM BAY
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State | FL
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Zip | 32907-2421
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Country | US
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Telephone | 321-327-4153
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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 | MRS. CEEAN HILL
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Credential |
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Telephone | 321-327-4153
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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 | 12327
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License Number State | FL
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