Provider Demographics
NPI:1457855355
Name:PARADISE LANE ADULT WORKSHOP
Entity Type:Organization
Organization Name:PARADISE LANE ADULT WORKSHOP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:OBODECHINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-498-1554
Mailing Address - Street 1:10503 ROCKLEY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099-3531
Mailing Address - Country:US
Mailing Address - Phone:281-498-1554
Mailing Address - Fax:
Practice Address - Street 1:10503 ROCKLEY RD STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-3531
Practice Address - Country:US
Practice Address - Phone:281-498-1554
Practice Address - Fax:281-529-6740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Single Specialty