Provider Demographics
NPI:1144688581
Name:ALF PARADISE INC
Entity type:Organization
Organization Name:ALF PARADISE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:HULDA ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON-EHRENPREIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:941-249-8787
Mailing Address - Street 1:866 TAMIAMI TRL
Mailing Address - Street 2:UNIT 8
Mailing Address - City:PT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33953-3103
Mailing Address - Country:US
Mailing Address - Phone:941-249-8787
Mailing Address - Fax:941-249-8744
Practice Address - Street 1:866 TAMIAMI TRL
Practice Address - Street 2:UNIT 8
Practice Address - City:PT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33953-3103
Practice Address - Country:US
Practice Address - Phone:941-249-8787
Practice Address - Fax:941-249-8744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-31
Last Update Date:2016-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9334261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9334OtherAHCA LICENSE