Provider Demographics
NPI:1750601480
Name:PARAGON OUTPATIENT THERAPY SERVICES, LLC.
Entity type:Organization
Organization Name:PARAGON OUTPATIENT THERAPY SERVICES, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:VELARDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-234-6685
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 1:7324 W CHEYENNE AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7427
Practice Address - Country:US
Practice Address - Phone:702-214-6685
Practice Address - Fax:702-214-6685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-04
Last Update Date:2010-06-04
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)