Provider Demographics
NPI:1417353376
Name:PARAGON SENIOR LIVING, LLC
Entity Type:Organization
Organization Name:PARAGON SENIOR LIVING, LLC
Other - Org Name:BENTLEY SENIOR LIVING AT PARAGON VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/COO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:DIOGUARDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-496-1505
Mailing Address - Street 1:427 U.S. HIGHWAY ROUTE 46
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840
Mailing Address - Country:US
Mailing Address - Phone:908-979-8080
Mailing Address - Fax:908-498-0202
Practice Address - Street 1:427 U.S. HIGHWAY ROUTE 46
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840
Practice Address - Country:US
Practice Address - Phone:908-979-8080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility