Provider Demographics
NPI:1659826576
Name:AGING HOME PARADISE LLC
Entity type:Organization
Organization Name:AGING HOME PARADISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EMMELYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CAPELLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-201-2513
Mailing Address - Street 1:110 ZACALO WAY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-9536
Mailing Address - Country:US
Mailing Address - Phone:407-201-2513
Mailing Address - Fax:
Practice Address - Street 1:110 ZACALO WAY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34743-9536
Practice Address - Country:US
Practice Address - Phone:407-201-2513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-20
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12865310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility