Provider Demographics
NPI:1205575172
Name:PARADISE CARE OF ORLANDO, INC
Entity type:Organization
Organization Name:PARADISE CARE OF ORLANDO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUNIOR
Authorized Official - Middle Name:S
Authorized Official - Last Name:CARRASCAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-421-8322
Mailing Address - Street 1:1700 N SEMORAN BLVD STE 136
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-3558
Mailing Address - Country:US
Mailing Address - Phone:407-903-6164
Mailing Address - Fax:407-903-6195
Practice Address - Street 1:1700 N SEMORAN BLVD STE 136
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3558
Practice Address - Country:US
Practice Address - Phone:407-903-6164
Practice Address - Fax:407-903-6195
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARADISE CARE OF ORLANDO, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110829500Medicaid