MEDICARE: PARADISE SPRINGS HOMES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	261QM0850X	Adult Mental Health Clinic/Center
3	324500000X	Substance Abuse Rehabilitation Facility

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	BH6860	OTHER	AZ	AZ DHS

General Provider Information

NPI Number	:	1932771417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARADISE SPRINGS HOMES

Provider Business Mailing Address
First Line	:	2777 S ARIZONA AVE APT 1183
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85286-1808
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5235 S AXIOM
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85212-8529
Country	:	US
Telephone Number	:	213-373-3549
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OF OPERATIONS
Name	:	GINA WILSON
Credential	:	MSW, LBHT
Telephone Number	:	213-373-3549

Provider Enumeration Date	:	07/14/2021
Last Update Date	:	11/13/2021

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Directions to “PARADISE SPRINGS HOMES ” Practice Location

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