MEDICARE: HEALING PARADISE

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	261QR0400X	Rehabilitation Clinic/Center	LC9852	FL

General Provider Information

NPI Number	:	1689950388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING PARADISE

Provider Business Mailing Address
First Line	:	8040 NW 95TH ST
Second Line	:	SUITE 220
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33016-2362
Country	:	US
Telephone Number	:	305-820-0440
Fax Number	:

Provider Business Practice Location Address
First Line	:	8040 NW 95TH ST
Second Line	:	SUITE 220
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33016-2362
Country	:	US
Telephone Number	:	305-820-0440
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. ILEN GONZALEZ
Credential	:
Telephone Number	:	305-820-0440

Provider Enumeration Date	:	10/25/2011
Last Update Date	:	10/25/2011

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Directions to “HEALING PARADISE ” Practice Location

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