Provider Demographics
NPI:1114818697
Name:PARAISO DOS GARDENIAS III LLC
Entity type:Organization
Organization Name:PARAISO DOS GARDENIAS III LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEON FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-749-3138
Mailing Address - Street 1:11360 NW 29TH ST
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-1659
Mailing Address - Country:US
Mailing Address - Phone:954-749-3138
Mailing Address - Fax:786-513-0427
Practice Address - Street 1:11360 NW 29TH ST
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-1659
Practice Address - Country:US
Practice Address - Phone:954-749-3138
Practice Address - Fax:786-513-0427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9462OtherAHCA