Provider Demographics
NPI:1124573027
Name:ROYAL PARADISE GROUP HOME INC
Entity Type:Organization
Organization Name:ROYAL PARADISE GROUP HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-305-7268
Mailing Address - Street 1:136 GRANADA ST
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-1307
Mailing Address - Country:US
Mailing Address - Phone:561-305-7268
Mailing Address - Fax:561-508-7494
Practice Address - Street 1:5496 COCONUT BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-8542
Practice Address - Country:US
Practice Address - Phone:561-305-7268
Practice Address - Fax:561-508-7494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-20
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003923400Medicaid