Organization
PARADISE RESIDENTIAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOCELYNE ININAHAZWE MA (CHIEF EXECUTIVE MANAGER)
(207) 636-0009
Entity
Organization
Contact information
Practice address
6 STEPHANIE DR, GORHAM, ME 04038-1394
(207) 636-0009
Mailing address
6 STEPHANIE DR, GORHAM, ME 04038-1394
(207) 636-0009
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
02/05/2020
Last updated
09/14/2021
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