Provider Demographics
NPI:1659327096
Name:PARAGON LONG TERM ACUTE CARE HOSPITAL
Entity Type:Organization
Organization Name:PARAGON LONG TERM ACUTE CARE HOSPITAL
Other - Org Name:PARAGON LTCH
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DUN
Authorized Official - Middle Name:
Authorized Official - Last Name:STOCKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-389-0412
Mailing Address - Street 1:4040 NORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-3829
Mailing Address - Country:US
Mailing Address - Phone:225-389-0412
Mailing Address - Fax:225-389-0413
Practice Address - Street 1:4040 NORTH BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-3829
Practice Address - Country:US
Practice Address - Phone:225-389-0412
Practice Address - Fax:225-389-0413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA582284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA582OtherSTATE LICENSE NUMBER
LA19-2039Medicare ID - Type UnspecifiedPROVIDER NUMBER