Provider Demographics
NPI:1871294843
Name:PARADISE RECOVERY COMMUNITY CENTER,LLC
Entity type:Organization
Organization Name:PARADISE RECOVERY COMMUNITY CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KENNEDY
Authorized Official - Middle Name:
Authorized Official - Last Name:AMUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:623-202-9583
Mailing Address - Street 1:18428 W MIAMI ST STE 18428
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-7490
Mailing Address - Country:US
Mailing Address - Phone:623-202-9583
Mailing Address - Fax:623-882-0715
Practice Address - Street 1:18428 W MIAMI ST STE 18428
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-7490
Practice Address - Country:US
Practice Address - Phone:623-202-9583
Practice Address - Fax:623-882-0715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health