NPI 1497210629

Paradise Group Home LLC

Organisation Point of Service Risco, MO

Practice location

Address: 121 Front Street, Risco, MO 63874
Phone: (573) 394-5020
Fax: (573) 394-5022
Mailing address: 208 N Ingram Rd, Sikeston, MO 63801-5233

Authorised official

Name: Jerrilyn Diane Adkisson
Title: Owner
Phone: (573) 471-3770

Registered specialties

Point of Service Primary

Managed Care Organizations Taxonomy 305S00000X

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Registry record

NPI: 1497210629
Entity type: Organization
NPI issued: 1 Feb 2019
Record last updated: 1 Feb 2019

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.