MEDICARE: PARADISE ADULTS CARE

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	311ZA0620X	Adult Care Home Facility	025013271I	GA

General Provider Information

NPI Number	:	1104172568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARADISE ADULTS CARE

Provider Business Mailing Address
First Line	:	PO BOX 30752
Second Line	:
City	:	WILMINGTON ISLAND
State	:	GA
Zip	:	31410-0752
Country	:	US
Telephone Number	:	912-323-8552
Fax Number	:

Provider Business Practice Location Address
First Line	:	124 ROPEMAKER LN
Second Line	:	4 BELVEDERE DRIVE
City	:	WILMINGTON ISLAND
State	:	GA
Zip	:	31410-2018
Country	:	US
Telephone Number	:	912-335-2991
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. JOANNE HARRIGAN
Credential	:
Telephone Number	:	912-323-8552

Provider Enumeration Date	:	08/02/2012
Last Update Date	:	08/02/2012

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Directions to “PARADISE ADULTS CARE ” Practice Location

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