Provider Demographics
NPI:1104608470
Name:PARADISE HILLS BOARD AND CARE
Entity type:Organization
Organization Name:PARADISE HILLS BOARD AND CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CAREGIVER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MASHO
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLDEGERIMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-519-2591
Mailing Address - Street 1:1580 ANTOINE DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92139-3948
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1580 ANTOINE DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92139-3948
Practice Address - Country:US
Practice Address - Phone:619-838-4658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility