Provider Demographics
NPI:1568231033
Name:SENIOR PARADISE LLC
Entity Type:Organization
Organization Name:SENIOR PARADISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARON
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDO
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:772-722-4077
Mailing Address - Street 1:3650 SW VICEROY ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-3733
Mailing Address - Country:US
Mailing Address - Phone:772-722-0477
Mailing Address - Fax:
Practice Address - Street 1:3650 SW VICEROY ST
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-3733
Practice Address - Country:US
Practice Address - Phone:772-722-0477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness