MEDICARE: PARAGON HOMES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1326731167
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARAGON HOMES LLC

Provider Business Mailing Address
First Line	:	9227 W MEADOWBROOK AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85037-2442
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9227 W MEADOWBROOK AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85037-2442
Country	:	US
Telephone Number	:	602-359-1706
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	TERENCE KIBUKAMUSOKE
Credential	:
Telephone Number	:	602-359-1706

Provider Enumeration Date	:	05/29/2023
Last Update Date	:	05/29/2023

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