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Organization
PARADISE ADOLESCENT HOME
Active
Organization
PARADISE ADOLESCENT HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANTWANETTE ELIZABETH EDWARDS MSW (COUNSELOR)
(407) 462-5593
Entity
Organization
Contact information
Practice address
136 VALDIVIA CIR, SAN RAMON, CA 94583-2228
(925) 901-0219
Mailing address
136 VALDIVIA CIR, SAN RAMON, CA 94583-2228
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
06/03/2021
Last updated
09/11/2024
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