Provider Demographics
NPI:1164151502
Name:GREAT PARADISE GROUP HOME LLC
Entity Type:Organization
Organization Name:GREAT PARADISE GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:TONY
Authorized Official - Last Name:LAZARRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-316-2220
Mailing Address - Street 1:6309 SW 18TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-2106
Mailing Address - Country:US
Mailing Address - Phone:786-316-2220
Mailing Address - Fax:954-827-8015
Practice Address - Street 1:6309 SW 18TH ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-2106
Practice Address - Country:US
Practice Address - Phone:786-316-2220
Practice Address - Fax:954-827-8015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services