=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972397743
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARADISE OF ADORATION LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2025
-----------------------------------------------------
Last Update Date | 04/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5110 PEACHGREEN CT
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33624-4877
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-504-6072
-----------------------------------------------------
Fax | 813-504-6072
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5110 PEACHGREEN CT
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33624-4877
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-504-6072
-----------------------------------------------------
Fax | 813-504-6072
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | PHYLLIS SKANNAL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 813-504-6072
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------