MEDICARE: PARADISE MEMORY CARE

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	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1629670450
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARADISE MEMORY CARE

Provider Business Mailing Address
First Line	:	243 SAXONDALE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-6010
Country	:	US
Telephone Number	:	725-600-7675
Fax Number	:

Provider Business Practice Location Address
First Line	:	243 SAXONDALE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-6010
Country	:	US
Telephone Number	:	725-600-7675
Fax Number	:

Authorized Official
Title or Position	:	FACILITY MANAGER
Name	:	CRISTINA LAZAR-LOPEZ
Credential	:
Telephone Number	:	702-235-2584

Provider Enumeration Date	:	11/16/2020
Last Update Date	:	11/16/2020

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Directions to “PARADISE MEMORY CARE ” Practice Location

Language	Start Address	Practice Location

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