Provider Demographics
NPI:1801475603
Name:BLUE PARADISE HEALTHCARE LLC
Entity type:Organization
Organization Name:BLUE PARADISE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDET
Authorized Official - Prefix:
Authorized Official - First Name:NURDENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA MORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-650-9598
Mailing Address - Street 1:100410 OVERSEAS HWY STE 202
Mailing Address - Street 2:
Mailing Address - City:KEY LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33037-2556
Mailing Address - Country:US
Mailing Address - Phone:786-650-9598
Mailing Address - Fax:
Practice Address - Street 1:100410 OVERSEAS HWY STE 202
Practice Address - Street 2:
Practice Address - City:KEY LARGO
Practice Address - State:FL
Practice Address - Zip Code:33037-2556
Practice Address - Country:US
Practice Address - Phone:786-650-9598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty