MEDICARE: PARAH INC ASSISTED LIVING FACILITY

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	310400000X	Assisted Living Facility	10780	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386811735
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARAH INC ASSISTED LIVING FACILITY

Provider Business Mailing Address
First Line	:	701 SW TULIP BLVD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-3304
Country	:	US
Telephone Number	:	772-878-6586
Fax Number	:	772-878-6586

Provider Business Practice Location Address
First Line	:	701 SW TULIP BLVD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-3304
Country	:	US
Telephone Number	:	772-878-6586
Fax Number	:	772-878-6586

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. BARBARA GAYLE
Credential	:
Telephone Number	:	772-878-6586

Provider Enumeration Date	:	05/14/2008
Last Update Date	:	05/14/2008

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