Provider Demographics
NPI:1235849779
Name:PARADISE LIFESTYLE LLC
Entity Type:Organization
Organization Name:PARADISE LIFESTYLE LLC
Other - Org Name:PARADISE LIFESTYLE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-699-9299
Mailing Address - Street 1:810 S ALMA SCHOOL RD STE 4
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-1091
Mailing Address - Country:US
Mailing Address - Phone:480-699-9299
Mailing Address - Fax:
Practice Address - Street 1:810 S ALMA SCHOOL RD STE 4
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-1091
Practice Address - Country:US
Practice Address - Phone:480-699-9299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-23
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty