MEDICARE: PARAISO ASSISTED LIVING 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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1417426438
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARAISO ASSISTED LIVING INC

Provider Business Mailing Address
First Line	:	6174 97TH TER N
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33782-3119
Country	:	US
Telephone Number	:	727-748-3320
Fax Number	:	727-362-1580

Provider Business Practice Location Address
First Line	:	6174 97TH TER N
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33782-3119
Country	:	US
Telephone Number	:	727-748-3320
Fax Number	:	727-362-1580

Authorized Official
Title or Position	:	VP
Name	:	MR. CHRISTOPHER DEMBOWSKI
Credential	:
Telephone Number	:	727-748-3320

Provider Enumeration Date	:	11/20/2018
Last Update Date	:	11/20/2018

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