Provider Demographics
NPI:1609184522
Name:PARADISE RESIDENTIAL CARE FACILITIES FOR THE ELDERLY
Entity Type:Organization
Organization Name:PARADISE RESIDENTIAL CARE FACILITIES FOR THE ELDERLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:FATTANEH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOGHADAM-YEKTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-342-9104
Mailing Address - Street 1:PO BOX 503916
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92150-3916
Mailing Address - Country:US
Mailing Address - Phone:760-728-1900
Mailing Address - Fax:858-672-5655
Practice Address - Street 1:1581 SYCAMORE DR
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-9100
Practice Address - Country:US
Practice Address - Phone:760-728-1900
Practice Address - Fax:760-728-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374601799251G00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No385H00000XRespite Care FacilityRespite Care