Organization
PARADISE RETREAT ASSISTED LIVING FACILITY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WARRENRINA LA'TARA HENDERSON (OWNER/ ADMINISTRATOR)
(904) 551-5046
Entity
Organization
Contact information
Practice address
5626 SOUTEL DR, JACKSONVILLE, FL 32219-3772
(904) 551-5046
(904) 551-5058
Mailing address
5626 SOUTEL DR, JACKSONVILLE, FL 32219-3772
(904) 551-5046
(904) 551-5058
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
AL12180
FL
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
08/08/2012
Last updated
08/08/2012
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