Provider Demographics
NPI:1972098515
Name:PARADISE DREAMS ENTERPRISES, LLC.
Entity Type:Organization
Organization Name:PARADISE DREAMS ENTERPRISES, LLC.
Other - Org Name:SMART START SPEECH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-903-7018
Mailing Address - Street 1:1350 KELSO DUNES AVE APT 1121
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-7858
Mailing Address - Country:US
Mailing Address - Phone:631-903-7018
Mailing Address - Fax:
Practice Address - Street 1:1350 KELSO DUNES AVE APT 1121
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-7858
Practice Address - Country:US
Practice Address - Phone:631-903-7018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1912190273Medicaid