Organization
PARADISE LODGE LLC
Active
Other names
New Dawn Behavioral Health
Organization subpart
No
Provider details
NPI number
Authorized official
ERNEST K AMPONSAH (ADMINISTRATOR)
(224) 595-0112
Entity
Organization
Contact information
Practice address
18860 N MARICOPA RD, MARICOPA, AZ 85139-1817
(122) 459-5011
Mailing address
43858 W LINDGREN DR, MARICOPA, AZ 85138-5523
(224) 595-0112
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Enumeration date
11/29/2023
Last updated
11/29/2023
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