Provider Demographics
NPI:1871016444
Name:GREEN PARADISE ADULT HOME CARE LLC.
Entity Type:Organization
Organization Name:GREEN PARADISE ADULT HOME CARE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:AVERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-503-1390
Mailing Address - Street 1:19801 TOMAHAWK RD
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-5013
Mailing Address - Country:US
Mailing Address - Phone:760-503-1390
Mailing Address - Fax:760-503-1390
Practice Address - Street 1:19801 TOMAHAWK RD
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-5013
Practice Address - Country:US
Practice Address - Phone:760-503-1390
Practice Address - Fax:760-503-1390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA336427614251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health