Provider Demographics
NPI:1801327663
Name:PARADIGM RECOVERY GROUP LLC
Entity type:Organization
Organization Name:PARADIGM RECOVERY GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:STENZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:184-438-8411
Mailing Address - Street 1:601 E DAILY DR STE 205
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-5839
Mailing Address - Country:US
Mailing Address - Phone:184-438-8410
Mailing Address - Fax:180-591-4063
Practice Address - Street 1:601 E DAILY DR STE 205
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-5839
Practice Address - Country:US
Practice Address - Phone:184-438-8410
Practice Address - Fax:180-591-4063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA06463665251B00000X, 251S00000X, 261QH0100X, 261QM0850X, 261QM1300X, 261QP2000X, 261QR0405X, 3245S0500X, 261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAN/AOtherN/A