Provider Demographics
NPI:1003415415
Name:PARAMOUNT COMMUNITY LIVING AND REHAB, INC.
Entity Type:Organization
Organization Name:PARAMOUNT COMMUNITY LIVING AND REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOPIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-504-9797
Mailing Address - Street 1:200 SW 14TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-4701
Mailing Address - Country:US
Mailing Address - Phone:316-283-4770
Mailing Address - Fax:
Practice Address - Street 1:200 SW 14TH ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-4701
Practice Address - Country:US
Practice Address - Phone:316-283-4770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-19
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS5392790Medicaid