Provider Demographics
NPI:1316222110
Name:PARADISE PEACE OF MIND HOME HEALTH CARE SERVICES, LLC
Entity Type:Organization
Organization Name:PARADISE PEACE OF MIND HOME HEALTH CARE SERVICES, LLC
Other - Org Name:PARADISE PEACE OF MIND ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CROUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-271-9349
Mailing Address - Street 1:10222 CHIMNEY HILL LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-2311
Mailing Address - Country:US
Mailing Address - Phone:469-271-9349
Mailing Address - Fax:
Practice Address - Street 1:10222 CHIMNEY HILL LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-2311
Practice Address - Country:US
Practice Address - Phone:214-616-9418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-13
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities