MEDICARE: PARADISE GROUP HOME AT NMB

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	11-1144-GH	FL

General Provider Information

NPI Number	:	1801264619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARADISE GROUP HOME AT NMB

Provider Business Mailing Address
First Line	:	1334 NE 151ST ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-5526
Country	:	US
Telephone Number	:	305-608-8784
Fax Number	:	305-608-8784

Provider Business Practice Location Address
First Line	:	1334 NE 151ST ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-5526
Country	:	US
Telephone Number	:	305-608-8784
Fax Number	:	305-608-8784

Authorized Official
Title or Position	:	OWNER
Name	:	MARIE FILIBERTA LETANG
Credential	:
Telephone Number	:	305-608-8784

Provider Enumeration Date	:	09/10/2015
Last Update Date	:	09/10/2015

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