Provider Demographics
NPI:1255864302
Name:A PARADISE HOME ALF II LLC
Entity Type:Organization
Organization Name:A PARADISE HOME ALF II LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINITRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:USHINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-586-7500
Mailing Address - Street 1:438 MACY ST
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33405-4423
Mailing Address - Country:US
Mailing Address - Phone:561-586-7500
Mailing Address - Fax:561-586-7500
Practice Address - Street 1:438 MACY ST
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33405-4423
Practice Address - Country:US
Practice Address - Phone:561-586-7500
Practice Address - Fax:561-586-7500
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A PARADISE HOME ALF INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12990310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008752700Medicaid