Paradise Port St Lucie, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL8585 Issued in FL

Legal business name

PARADISE PORT ST LUCIE, LLC

Doing business as

Paradise Care Cottage

Practice address

2277 SE Lennard Rd
Port St Lucie, FL 34952-6889

Phone

(772) 398-8899

Fax

(772) 398-3322

NPI assigned

May 13, 2008

Last updated

May 13, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Tina Rose Bass

Title

Administrator

Phone

(772) 398-8899

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Paradise Care Cottage Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1210636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210636800000",
    "number": "1407023054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2277 SE LENNARD RD",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349526889",
            "telephone_number": "772-398-8899",
            "fax_number": "772-398-3322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2277 SE LENNARD RD",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349526889",
            "telephone_number": "772-398-8899",
            "fax_number": "772-398-3322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARADISE PORT ST LUCIE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-13",
        "last_updated": "2008-05-13",
        "status": "A",
        "authorized_official_last_name": "BASS",
        "authorized_official_first_name": "TINA",
        "authorized_official_middle_name": "ROSE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "772-398-8899",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL8585",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "679064000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Paradise Care Cottage",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Randall Panckeri
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• Elizabeth Ashley Pare, D.M.D.
• Sushma Parekh, MD
• Heather Parent, RBT
• Martie Parker-Lovely, M.ED

• Assisted Living Facility in Port St Lucie, FL
• Providers in Port St Lucie, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.