Provider Demographics
NPI:1427267541
Name:PARADISE ADULT CENTER, INC.
Entity type:Organization
Organization Name:PARADISE ADULT CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIURKA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROJAS LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-768-0498
Mailing Address - Street 1:480 W 66 ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-6667
Mailing Address - Country:US
Mailing Address - Phone:305-822-0994
Mailing Address - Fax:305-822-0121
Practice Address - Street 1:480 W 66 ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-6667
Practice Address - Country:US
Practice Address - Phone:786-277-9822
Practice Address - Fax:305-822-0121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10747310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL142499800Medicaid
FL693137500OtherMEDICAID WAIVER