Provider Demographics
NPI:1598317000
Name:SENIORS PARADISE HOMECARE AGENCY LLC
Entity Type:Organization
Organization Name:SENIORS PARADISE HOMECARE AGENCY LLC
Other - Org Name:SENIORS PARADISE HOMECARE AGENCY LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMAROO
Authorized Official - Middle Name:
Authorized Official - Last Name:DIONNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-704-3901
Mailing Address - Street 1:489 STARRATT RD LOT 45
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-2885
Mailing Address - Country:US
Mailing Address - Phone:904-704-3901
Mailing Address - Fax:
Practice Address - Street 1:12373 HAGAN CREEK DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-8319
Practice Address - Country:US
Practice Address - Phone:904-704-3901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-15
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care