Provider Demographics
NPI:1801626015
Name:PARADISE, MCKENZIE CORY
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:CORY
Last Name:PARADISE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:MCKENZIE
Other - Middle Name:CORY
Other - Last Name:STEVERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8787 SIENNA SPRINGS BLVD APT 1212
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-6078
Mailing Address - Country:US
Mailing Address - Phone:661-472-1676
Mailing Address - Fax:
Practice Address - Street 1:8787 SIENNA SPRINGS BLVD APT 1212
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-6078
Practice Address - Country:US
Practice Address - Phone:661-472-1676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-02
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No253J00000XAgenciesFoster Care Agency
No385H00000XRespite Care FacilityRespite Care
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child