Provider Demographics
NPI:1891920724
Name:PARADISE 2 PRP LLC
Entity Type:Organization
Organization Name:PARADISE 2 PRP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERNYAKHOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-691-8522
Mailing Address - Street 1:7902 BELAIR RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-3707
Mailing Address - Country:US
Mailing Address - Phone:443-691-8522
Mailing Address - Fax:410-325-1642
Practice Address - Street 1:7902 BELAIR RD
Practice Address - Street 2:SUITE 4
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-3707
Practice Address - Country:US
Practice Address - Phone:443-691-8522
Practice Address - Fax:410-325-1642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23093261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health