Organization
PARADISE LODGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERNEST KWESI AMPONSAH (ADMINISTRATOR)
(224) 595-0112
Entity
Organization
Contact information
Practice address
43858 W LINDGREN DR, MARICOPA, AZ 85138-5523
(520) 246-5998
(520) 246-5994
Mailing address
43858 W LINDGREN DR, MARICOPA, AZ 85138-5523
(520) 246-5998
(520) 246-5994
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
323P00000X
Psychiatric Residential Treatment Facility
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
07/07/2021
Last updated
07/07/2021
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