MEDICARE: PARADISE PARK PLACE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1093423980
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARADISE PARK PLACE LLC

Provider Business Mailing Address
First Line	:	8514 LAMBERT DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-5267
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3159 DESMOND AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5613
Country	:	US
Telephone Number	:	702-333-0775
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	OLIVER NAIDAS
Credential	:
Telephone Number	:	702-281-6677

Provider Enumeration Date	:	11/09/2022
Last Update Date	:	11/09/2022

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Directions to “PARADISE PARK PLACE LLC ” Practice Location

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