Organization
PARADISE GROUP HOME LLC
Active
Organization
PARADISE GROUP HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JERRILYN DIANE ADKISSON (OWNER)
(573) 471-3770
Entity
Organization
Contact information
Practice address
121 FRONT STREET, RISCO, MO 63874
(573) 394-5020
(573) 394-5022
Mailing address
208 N INGRAM RD, SIKESTON, MO 63801-5233
(573) 471-3770
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
—
—
Other
Enumeration date
02/01/2019
Last updated
02/01/2019
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