MEDICARE: PARADISE 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	347C00000X	Private Vehicle

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548593296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARADISE LLC

Provider Business Mailing Address
First Line	:	10691 E BETHANY DR
Second Line	:	UNIT 900
City	:	AURORA
State	:	CO
Zip	:	80014-2643
Country	:	US
Telephone Number	:	720-220-1377
Fax Number	:

Provider Business Practice Location Address
First Line	:	10691 E BETHANY DR
Second Line	:	UNIT 900
City	:	AURORA
State	:	CO
Zip	:	80014-2643
Country	:	US
Telephone Number	:	720-220-1377
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	BORIS SMORODA
Credential	:
Telephone Number	:	720-220-1377

Provider Enumeration Date	:	09/14/2009
Last Update Date	:	09/14/2009

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Directions to “PARADISE LLC ” Practice Location

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