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General NPI Number Information
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NPI Number | 1902412182
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Entity Type | Organization
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Legal Business Name | PARADISE ADOLESCENT HOMES, INC.
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Dates
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Enumeration Date | 09/22/2020
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Last Update Date | 07/26/2023
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Provider Practice Location Address
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Address Line | 136 VALDIVIA CIR
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City | SAN RAMON
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State | CA
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Zip | 94583-2228
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Country | US
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Telephone | 925-901-0219
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Fax | 925-901-1300
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Provider Business Mailing Address
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Address Line | PO BOX 626
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City | SAN RAMON
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State | CA
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Zip | 94583-0626
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Country | US
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Telephone | 925-901-0219
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Fax | 925-901-1300
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MARITZA JEFFERSON-GREGORY
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Credential |
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Telephone | 925-570-8498
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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