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General NPI Number Information
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NPI Number | 1952780959
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Entity Type | Organization
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Legal Business Name | PARADISE LIVING
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Dates
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Enumeration Date | 05/22/2015
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Last Update Date | 05/22/2015
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Provider Practice Location Address
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Address Line | 258 COLLEGE AVE
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City | MAYSVILLE
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State | GA
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Zip | 30558-1828
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Country | US
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Telephone | 706-652-2600
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Fax | 706-652-3523
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Provider Business Mailing Address
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Address Line | 258 COLLEGE AVE
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City | MAYSVILLE
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State | GA
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Zip | 30558-1828
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Country | US
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Telephone | 706-652-2600
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Fax | 706-652-3523
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Authorized Official
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Title or Position | OWNER
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Name | MR. HAMID NIKFARJAM
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Credential |
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Telephone | 706-652-2600
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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 | PCH009059
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License Number State | GA
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