Provider Demographics
NPI:1740897784
Name:PARADISE ADOLESCENT HOMES, INC.
Entity type:Organization
Organization Name:PARADISE ADOLESCENT HOMES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFERSON-GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-570-8498
Mailing Address - Street 1:PO BOX 626
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-0626
Mailing Address - Country:US
Mailing Address - Phone:925-901-0219
Mailing Address - Fax:
Practice Address - Street 1:602 WOODLARK DR
Practice Address - Street 2:
Practice Address - City:SUISUN CITY
Practice Address - State:CA
Practice Address - Zip Code:94585-2244
Practice Address - Country:US
Practice Address - Phone:707-399-8907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-24
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children