Healthcare Provider Details

I. General information

NPI: 1477786226
Provider Name (Legal Business Name): PARAGON HEALTHCARE OF ARIZONA,LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2585 S MIRACLE MILE SUITE 107
BULLHEAD CITY AZ
86442-7522
US

IV. Provider business mailing address

2585 MIRACLE MILE SUITE 107
BULLHEAD CITY AZ
86442-7522
US

V. Phone/Fax

Practice location:
  • Phone: 928-444-8168
  • Fax: 928-444-8169
Mailing address:
  • Phone: 928-444-8168
  • Fax: 928-444-8169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251C2600X
TaxonomyCardiopulmonary Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: SAM W SPEAR
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 924-444-8168