Provider Demographics
NPI:1679804603
Name:COUNTY PARADISE ASSISTED LIVING
Entity type:Organization
Organization Name:COUNTY PARADISE ASSISTED LIVING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO, RN
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:STELLA
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:478-456-9296
Mailing Address - Street 1:PO BOX 82
Mailing Address - Street 2:546 MACON ROAD
Mailing Address - City:MCINTYRE
Mailing Address - State:GA
Mailing Address - Zip Code:31054
Mailing Address - Country:US
Mailing Address - Phone:478-946-3164
Mailing Address - Fax:478-628-6042
Practice Address - Street 1:546 MACON ROAD
Practice Address - Street 2:
Practice Address - City:MCINTYRE
Practice Address - State:GA
Practice Address - Zip Code:31054
Practice Address - Country:US
Practice Address - Phone:478-946-3164
Practice Address - Fax:478-628-6042
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY PARADISE ASSISTED LIVING/PRN NURSING SOLUTIONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN102334163WA0400X, 310400000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living FacilityGroup - Multi-Specialty
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)Group - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty