Provider Demographics
NPI:1104181486
Name:PARADISE HEALING RETREAT
Entity Type:Organization
Organization Name:PARADISE HEALING RETREAT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SOOK
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:ACUPUNCTURIST
Authorized Official - Phone:480-483-0969
Mailing Address - Street 1:7139 E THUNDERBIRD RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-4075
Mailing Address - Country:US
Mailing Address - Phone:480-483-0969
Mailing Address - Fax:480-483-0968
Practice Address - Street 1:7139 E THUNDERBIRD RD
Practice Address - Street 2:SUITE 2
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4075
Practice Address - Country:US
Practice Address - Phone:480-483-0969
Practice Address - Fax:480-483-0968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0839261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center