Provider Demographics
NPI:1689950388
Name:HEALING PARADISE
Entity Type:Organization
Organization Name:HEALING PARADISE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ILEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-820-0440
Mailing Address - Street 1:8040 NW 95TH ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2362
Mailing Address - Country:US
Mailing Address - Phone:305-820-0440
Mailing Address - Fax:
Practice Address - Street 1:8040 NW 95TH ST
Practice Address - Street 2:SUITE 220
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33016-2362
Practice Address - Country:US
Practice Address - Phone:305-820-0440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLC9852261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherPRIVATE INSURANCE