MEDICARE: PARADISE HOME CARE 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	3747P1801X	Personal Care Attendant
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1275297681
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARADISE HOME CARE LLC

Provider Business Mailing Address
First Line	:	4040 E MCDOWELL RD STE 412
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-4448
Country	:	US
Telephone Number	:	602-410-9871
Fax Number	:

Provider Business Practice Location Address
First Line	:	4040 E MCDOWELL RD STE 412
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-4448
Country	:	US
Telephone Number	:	602-410-9871
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DIRIBA FEYISSA
Credential	:
Telephone Number	:	602-410-9871

Provider Enumeration Date	:	10/22/2021
Last Update Date	:	02/15/2022

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Directions to “PARADISE HOME CARE LLC ” Practice Location

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