Provider Demographics
NPI:1528563145
Name:EVELYN'S PARADISE #1 LLC
Entity Type:Organization
Organization Name:EVELYN'S PARADISE #1 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ALF OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCIAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-234-6619
Mailing Address - Street 1:11470 SW 80TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3606
Mailing Address - Country:US
Mailing Address - Phone:786-234-6619
Mailing Address - Fax:
Practice Address - Street 1:11470 SW 80TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3606
Practice Address - Country:US
Practice Address - Phone:786-234-6619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility