Provider Demographics
NPI:1952018327
Name:HISTORIC PARADISE FOUNDATION NFP
Entity Type:Organization
Organization Name:HISTORIC PARADISE FOUNDATION NFP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:REDMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-887-0742
Mailing Address - Street 1:3160 HIGHWAY 21 SUITE 103
Mailing Address - Street 2:BOX 6
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715
Mailing Address - Country:US
Mailing Address - Phone:803-547-8555
Mailing Address - Fax:
Practice Address - Street 1:1162 FORT MILL HWY STE A
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29707-7698
Practice Address - Country:US
Practice Address - Phone:803-547-8555
Practice Address - Fax:312-256-9714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No174200000XOther Service ProvidersMeals
No251300000XAgenciesLocal Education Agency (LEA)
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251V00000XAgenciesVoluntary or Charitable
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No332U00000XSuppliersHome Delivered Meals
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No385HR2050XRespite Care FacilityRespite CareRespite Care Camp