Provider Demographics
NPI:1023638418
Name:PARADISE BEHAVIORAL HEALTH CENTER LLC
Entity type:Organization
Organization Name:PARADISE BEHAVIORAL HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAQUAISHA
Authorized Official - Middle Name:DANTRICE
Authorized Official - Last Name:HYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-690-0785
Mailing Address - Street 1:4912 CINNAMON SPICE CT
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-2587
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4912 CINNAMON SPICE CT
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-2587
Practice Address - Country:US
Practice Address - Phone:702-690-0785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-26
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1912205394Medicaid