Provider Demographics
NPI:1073370052
Name:BYRD'S OF PARADISE
Entity Type:Organization
Organization Name:BYRD'S OF PARADISE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMAL
Authorized Official - Middle Name:STEPHON
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-383-6253
Mailing Address - Street 1:5016 BERGENLINE AVE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-5522
Mailing Address - Country:US
Mailing Address - Phone:856-383-6253
Mailing Address - Fax:
Practice Address - Street 1:5016 BERGENLINE AVE UNIT 2
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-5522
Practice Address - Country:US
Practice Address - Phone:856-383-6253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty