# PARADISE LAKE SENIOR CARE HOME, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932508868
- **Authorized official:** THERESA FRIGILLANA RN, BSN (AFH PROVIDER)
- **Authorized official phone:** (425) 761-7739

## Contact information

- **Practice address:** 10121 219TH ST SE, SNOHOMISH, WA 98296-4941
- **Practice address phone:** (425) 761-7739
- **Practice address fax:** (360) 668-5297
- **Mailing address:** 10121 219TH ST SE, SNOHOMISH, WA 98296-4941
- **Mailing address phone:** (425) 761-7739

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | 751477 | WA | Yes |

## Other

- **Enumeration date:** 08/15/2014
- **Last updated:** 08/15/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 515305 | — | WA |