Provider Demographics
NPI:1972257939
Name:PARADISE ABODE BEHAVIORAL
Entity Type:Organization
Organization Name:PARADISE ABODE BEHAVIORAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREEMAT
Authorized Official - Middle Name:
Authorized Official - Last Name:OSHODI
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:602-326-2682
Mailing Address - Street 1:12362 W JOBLANCA RD
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-3130
Mailing Address - Country:US
Mailing Address - Phone:602-326-2682
Mailing Address - Fax:
Practice Address - Street 1:15204 W WESTVIEW DR
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-8292
Practice Address - Country:US
Practice Address - Phone:602-326-2682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ00Medicaid