Provider Demographics
NPI:1801422605
Name:PARADISE HEALTH CARE SERVICES, LLC
Entity type:Organization
Organization Name:PARADISE HEALTH CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REGENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FULMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-319-8858
Mailing Address - Street 1:2246 BELLAIRE DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-6304
Mailing Address - Country:US
Mailing Address - Phone:910-331-2785
Mailing Address - Fax:
Practice Address - Street 1:2246 BELLAIRE DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6304
Practice Address - Country:US
Practice Address - Phone:910-331-2785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-12
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health