1821162710 NPI number — PARAGON OUTPATIENT THERAPY SERVICES,LLC

Table of content: (NPI 1821162710)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821162710 NPI number — PARAGON OUTPATIENT THERAPY SERVICES,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARAGON OUTPATIENT THERAPY SERVICES,LLC
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:
PARAGON HEALTHCARE
Provider Other Organization Name Type Code:
3
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:
1821162710
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2011
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:
SUITE 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:
1655 W. HORIZON RIDGE PKWY.
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89012-3494
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-914-2790
Provider Business Practice Location Address Fax Number:
702-914-5984
Provider Enumeration Date:
11/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCKIERNAN
Authorized Official First Name:
MICHELE
Authorized Official Middle Name:
VICTORIA
Authorized Official Title or Position:
CHIEF ADMINISTRATOR
Authorized Official Telephone Number:
702-914-2790

Provider Taxonomy Codes

  • Taxonomy code: 261QR0401X , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100501129 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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