Provider Demographics
NPI:1619251618
Name:PARADISE GARDENS ALF
Entity Type:Organization
Organization Name:PARADISE GARDENS ALF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRALERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-954-3338
Mailing Address - Street 1:5851 52ND AVE N
Mailing Address - Street 2:
Mailing Address - City:KENNETH CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33709-3436
Mailing Address - Country:US
Mailing Address - Phone:727-954-3338
Mailing Address - Fax:
Practice Address - Street 1:5851 52ND AVE N
Practice Address - Street 2:
Practice Address - City:KENNETH CITY
Practice Address - State:FL
Practice Address - Zip Code:33709-3436
Practice Address - Country:US
Practice Address - Phone:727-954-3338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-08
Last Update Date:2011-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12070310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility