Provider Demographics
NPI:1396216172
Name:PARADISE HOME CARE SERVICES
Entity Type:Organization
Organization Name:PARADISE HOME CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YOUSSIF
Authorized Official - Middle Name:AHMED
Authorized Official - Last Name:GURUZA
Authorized Official - Suffix:
Authorized Official - Credentials:PHTEC
Authorized Official - Phone:865-255-2994
Mailing Address - Street 1:603 JADE RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-3132
Mailing Address - Country:US
Mailing Address - Phone:865-255-2994
Mailing Address - Fax:
Practice Address - Street 1:603 JADE RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-3132
Practice Address - Country:US
Practice Address - Phone:865-255-2994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN823662407Medicaid