Provider Demographics
NPI:1801264619
Name:PARADISE GROUP HOME AT NMB
Entity type:Organization
Organization Name:PARADISE GROUP HOME AT NMB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE FILIBERTA
Authorized Official - Middle Name:
Authorized Official - Last Name:LETANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-608-8784
Mailing Address - Street 1:1334 NE 151ST ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-5526
Mailing Address - Country:US
Mailing Address - Phone:305-608-8784
Mailing Address - Fax:305-608-8784
Practice Address - Street 1:1334 NE 151ST ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-5526
Practice Address - Country:US
Practice Address - Phone:305-608-8784
Practice Address - Fax:305-608-8784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11-1144-GH311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home