Provider Demographics
NPI:1013008259
Name:PARADISE CARE HOMES LLC
Entity Type:Organization
Organization Name:PARADISE CARE HOMES LLC
Other - Org Name:PARADISE 1 AT PRESCOTT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-541-1514
Mailing Address - Street 1:1812 WILLOW CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1157
Mailing Address - Country:US
Mailing Address - Phone:928-541-1514
Mailing Address - Fax:928-541-1514
Practice Address - Street 1:1812 WILLOW CREEK RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1157
Practice Address - Country:US
Practice Address - Phone:928-541-1514
Practice Address - Fax:928-541-1514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH-4989310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ123293OtherAHCCCS