Paradise Lake Senior Care Home, LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

751477 Issued in WA

Legal business name

PARADISE LAKE SENIOR CARE HOME, LLC

Practice address

10121 219TH St SE
Snohomish, WA 98296-4941

Phone

(425) 761-7739

Fax

(360) 668-5297

NPI assigned

Aug 15, 2014

Organization subpart

No

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

Authorized official

Name

Theresa Frigillana, RN, BSN

Title

Afh Provider

Phone

(425) 761-7739

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1408060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1408060800000",
    "number": "1932508868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10121 219TH ST SE",
            "city": "SNOHOMISH",
            "state": "WA",
            "postal_code": "982964941",
            "telephone_number": "425-761-7739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10121 219TH ST SE",
            "city": "SNOHOMISH",
            "state": "WA",
            "postal_code": "982964941",
            "telephone_number": "425-761-7739",
            "fax_number": "360-668-5297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARADISE LAKE SENIOR CARE HOME, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-15",
        "last_updated": "2014-08-15",
        "status": "A",
        "authorized_official_last_name": "FRIGILLANA",
        "authorized_official_first_name": "THERESA",
        "authorized_official_title_or_position": "AFH PROVIDER",
        "authorized_official_telephone_number": "425-761-7739",
        "authorized_official_credential": "RN, BSN"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "WA",
            "license": "751477",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "515305",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nency A Orozco, MEDICAL INTERPRETER
• Christopher J Overfield, LMP
• Pacific Wellness Home Visit LLC
• Pacifica SL Snohomish
• Leslie Palmer, RN, BSN
• Emily Parker, LMHCA
• Kenneth Eldon Parker, DC
• Jennifer Parrott
• Susan Lynn Patterson, LMHC
• Paul J. Lund DDS PLLC

• Adult Care Home Facility in Snohomish, WA
• Providers in Snohomish, WA by specialty
• Adult Care Home Facility in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2014; 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.