Provider Demographics
NPI:1104458090
Name:PARADISE CREEK HOMES
Entity type:Organization
Organization Name:PARADISE CREEK HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CLOVIS
Authorized Official - Middle Name:HERMANN
Authorized Official - Last Name:LAWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-718-9939
Mailing Address - Street 1:10511 E CORBIN AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212
Mailing Address - Country:US
Mailing Address - Phone:480-331-4160
Mailing Address - Fax:
Practice Address - Street 1:42714 N MURPHY AVE
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85140-9813
Practice Address - Country:US
Practice Address - Phone:202-718-9939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility