Provider Demographics
NPI:1821162710
Name:PARAGON OUTPATIENT THERAPY SERVICES,LLC
Entity Type:Organization
Organization Name:PARAGON OUTPATIENT THERAPY SERVICES,LLC
Other - Org Name:PARAGON HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:MCKIERNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:702-914-2790
Mailing Address - Street 1:1655 W. HORIZON RIDGE PKWY.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-3494
Mailing Address - Country:US
Mailing Address - Phone:702-914-2790
Mailing Address - Fax:702-914-5984
Practice Address - Street 1:1655 W. HORIZON RIDGE PKWY.
Practice Address - Street 2:SUITE 100
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-3494
Practice Address - Country:US
Practice Address - Phone:702-914-2790
Practice Address - Fax:702-914-5984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100501129Medicaid
NV100501129Medicaid