Provider Demographics
NPI:1689421661
Name:PARADISE INDEPENDENT CARE INC
Entity type:Organization
Organization Name:PARADISE INDEPENDENT CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KNARIK
Authorized Official - Middle Name:NAR
Authorized Official - Last Name:DAVTYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-601-0013
Mailing Address - Street 1:8915 WOODMAN AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:ARLETA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-8020
Mailing Address - Country:US
Mailing Address - Phone:818-601-0013
Mailing Address - Fax:818-279-0903
Practice Address - Street 1:8915 WOODMAN AVE UNIT A
Practice Address - Street 2:
Practice Address - City:ARLETA
Practice Address - State:CA
Practice Address - Zip Code:91331-8020
Practice Address - Country:US
Practice Address - Phone:818-601-0013
Practice Address - Fax:818-279-0903
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARADISE INDEPENDENT CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-06
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care