Provider Demographics
NPI:1215462288
Name:PARADISE BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:PARADISE BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIZYL
Authorized Official - Middle Name:F
Authorized Official - Last Name:DAMAYO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-347-8341
Mailing Address - Street 1:25097 OLYMPIA AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-3914
Mailing Address - Country:US
Mailing Address - Phone:941-347-8341
Mailing Address - Fax:941-347-7702
Practice Address - Street 1:25097 OLYMPIA AVE STE 201
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3914
Practice Address - Country:US
Practice Address - Phone:941-347-8341
Practice Address - Fax:941-347-7702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-26
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME114111261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103283300Medicaid