Provider Demographics
NPI:1205262276
Name:PARADISE VILLA RETIREMENT HOMES INC
Entity type:Organization
Organization Name:PARADISE VILLA RETIREMENT HOMES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:954-444-1306
Mailing Address - Street 1:4275 NW 67TH WAY
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-3025
Mailing Address - Country:US
Mailing Address - Phone:954-755-5432
Mailing Address - Fax:
Practice Address - Street 1:4275 NW 67TH WAY
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-3025
Practice Address - Country:US
Practice Address - Phone:954-755-5432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-22
Last Update Date:2013-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11508310400000X
FLAL11931310400000X
FLAL 9225310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility