Provider Demographics
NPI:1649021767
Name:PARADYSE HOME CARE LLC
Entity type:Organization
Organization Name:PARADYSE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANVILLE-WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-818-7786
Mailing Address - Street 1:5702 LINCOLN CIR E
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-6757
Mailing Address - Country:US
Mailing Address - Phone:561-818-7786
Mailing Address - Fax:
Practice Address - Street 1:5702 LINCOLN CIR E
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-6757
Practice Address - Country:US
Practice Address - Phone:561-818-7786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility