Provider Demographics
NPI:1235432899
Name:PARADIGM REHAB & HEALTH CARE, LLC
Entity Type:Organization
Organization Name:PARADIGM REHAB & HEALTH CARE, LLC
Other - Org Name:PARADIGM HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WILLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-581-1223
Mailing Address - Street 1:PO BOX 130010
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75713-0010
Mailing Address - Country:US
Mailing Address - Phone:903-581-1223
Mailing Address - Fax:
Practice Address - Street 1:4965 PRESTON PARK BLVD STE 120
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5143
Practice Address - Country:US
Practice Address - Phone:972-422-0033
Practice Address - Fax:972-736-0068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX014152OtherHCSSA LICENSE
TX3257263Medicaid
TX3257263Medicaid