1063647428 NPI number — PARAGON OUTPATIENT THERAPY SERVICES

Table of content: (NPI 1063647428)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063647428 NPI number — PARAGON OUTPATIENT THERAPY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARAGON OUTPATIENT THERAPY SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063647428
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1655 W HORIZON RIDGE PKWY
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89012-3494
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-914-2790
Provider Business Mailing Address Fax Number:
702-914-5984

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7324 W CHEYENNE AVE
Provider Second Line Business Practice Location Address:
STE 7
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89129-7427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-214-6665
Provider Business Practice Location Address Fax Number:
702-214-6865
Provider Enumeration Date:
05/28/2009

Additional Information

Authorized Official

Authorized Official Last Name:
CORSINO
Authorized Official First Name:
MEG
Authorized Official Middle Name:
T
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
702-214-6665

Provider Taxonomy Codes

  • Taxonomy code: 2279P1005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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