Provider Demographics
NPI:1629254693
Name:BIRD OF PARADISE @ SUNCOAST
Entity Type:Organization
Organization Name:BIRD OF PARADISE @ SUNCOAST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MERLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALCIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-751-9788
Mailing Address - Street 1:10902 WILDCAT DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-7778
Mailing Address - Country:US
Mailing Address - Phone:813-810-7279
Mailing Address - Fax:
Practice Address - Street 1:10902 WILDCAT DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-7778
Practice Address - Country:US
Practice Address - Phone:813-810-7279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-21
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child