Provider Demographics
NPI:1275297681
Name:PARADISE HOME CARE LLC
Entity Type:Organization
Organization Name:PARADISE HOME CARE LLC
Other - Org Name:PARADISE HOME CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIRIBA
Authorized Official - Middle Name:
Authorized Official - Last Name:FEYISSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-410-9871
Mailing Address - Street 1:4040 E MCDOWELL RD STE 412
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-4448
Mailing Address - Country:US
Mailing Address - Phone:602-410-9871
Mailing Address - Fax:
Practice Address - Street 1:4040 E MCDOWELL RD STE 412
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-4448
Practice Address - Country:US
Practice Address - Phone:602-410-9871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty