Provider Demographics
NPI:1801144001
Name:PARADISE MANOR 1, LLC
Entity type:Organization
Organization Name:PARADISE MANOR 1, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERNESTA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-595-6229
Mailing Address - Street 1:5645 E NISBET RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2433
Mailing Address - Country:US
Mailing Address - Phone:602-595-6229
Mailing Address - Fax:408-595-6229
Practice Address - Street 1:13614 N 89TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-7653
Practice Address - Country:US
Practice Address - Phone:602-740-0546
Practice Address - Fax:408-519-6589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-17
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL8718H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility