Provider Demographics
NPI:1720677883
Name:PARADIGM TREATMENT CENTERS, LLC
Entity Type:Organization
Organization Name:PARADIGM TREATMENT CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:COLE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-457-6300
Mailing Address - Street 1:12424 WILSHIRE BLVD STE 750
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1079
Mailing Address - Country:US
Mailing Address - Phone:310-457-6300
Mailing Address - Fax:310-457-6318
Practice Address - Street 1:7345 BIRDVIEW AVE
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-4112
Practice Address - Country:US
Practice Address - Phone:310-457-6300
Practice Address - Fax:310-457-6318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility