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General NPI Number Information
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NPI Number | 1982848875
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Entity Type | Organization
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Legal Business Name | PARADYM SENIOR LIFE, LLC
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Dates
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Enumeration Date | 04/23/2009
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Last Update Date | 04/23/2009
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Provider Practice Location Address
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Address Line | 11139 FOST LANE
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City | HAMMOND
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State | LA
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Zip | 70403
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Country | US
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Telephone | 225-294-0401
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Fax | 225-294-0301
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Provider Business Mailing Address
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Address Line | PO BOX 850
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City | SPRINGFIELD
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State | LA
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Zip | 70462-0850
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Country | US
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Telephone | 225-294-0401
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Fax | 225-294-0301
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Authorized Official
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Title or Position | OWNER
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Name | WILLIAM L PRATT
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Credential |
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Telephone | 225-294-0401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 35176177K
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License Number State | LA
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