MEDICARE: PARADISE HOME CARE, INC.

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1245484195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARADISE HOME CARE, INC.

Provider Business Mailing Address
First Line	:	4906 CUTSHAW AVE STE 102
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-3630
Country	:	US
Telephone Number	:	804-562-6604
Fax Number	:	804-308-0551

Provider Business Practice Location Address
First Line	:	4906 CUTSHAW AVE STE 102
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-3630
Country	:	US
Telephone Number	:	804-562-6604
Fax Number	:	804-308-0551

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MRS. KATHLEEN S LEVENSTON
Credential	:	LCSW
Telephone Number	:	804-562-6604

Provider Enumeration Date	:	11/05/2008
Last Update Date	:	03/20/2009

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Directions to “PARADISE HOME CARE, INC. ” Practice Location

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