Provider Demographics
NPI:1376540047
Name:PARADIGM REHAB & NURSING LP
Entity Type:Organization
Organization Name:PARADIGM REHAB & NURSING LP
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 1:777 S BROADWAY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1607
Practice Address - Country:US
Practice Address - Phone:903-581-1223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009541251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1764417Medicaid
TX009541OtherSTATE HHA LICENSE NUMBER
TX1764417Medicaid