Provider Demographics
NPI:1548593296
Name:PARADISE LLC
Entity type:Organization
Organization Name:PARADISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SMORODA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-220-1377
Mailing Address - Street 1:10691 E BETHANY DR
Mailing Address - Street 2:UNIT 900
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-2643
Mailing Address - Country:US
Mailing Address - Phone:720-220-1377
Mailing Address - Fax:
Practice Address - Street 1:10691 E BETHANY DR
Practice Address - Street 2:UNIT 900
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2643
Practice Address - Country:US
Practice Address - Phone:720-220-1377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO96507080Medicaid
CO38776561Medicaid