Provider Demographics
NPI:1679063358
Name:A PARADISE HOME ALF III LLC
Entity Type:Organization
Organization Name:A PARADISE HOME ALF III LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-486-9869
Mailing Address - Street 1:733 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-4303
Mailing Address - Country:US
Mailing Address - Phone:786-486-9869
Mailing Address - Fax:954-580-7092
Practice Address - Street 1:733 S 11TH ST
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-4303
Practice Address - Country:US
Practice Address - Phone:786-486-9869
Practice Address - Fax:954-580-7092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOOOOOOOOMedicaid