Provider Demographics
NPI:1811194764
Name:PARADIGM, INC.
Entity Type:Organization
Organization Name:PARADIGM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:T
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:252-714-1230
Mailing Address - Street 1:PO BOX 31091
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27833-1091
Mailing Address - Country:US
Mailing Address - Phone:252-561-8112
Mailing Address - Fax:252-561-7455
Practice Address - Street 1:4001 OLD PACTOLUS RD # A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-0701
Practice Address - Country:US
Practice Address - Phone:252-561-8112
Practice Address - Fax:252-561-7455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-074-136251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301107GMedicaid