Healthcare Provider Details

I. General information

NPI: 1801342597
Provider Name (Legal Business Name): PARAGON RESTORATION & BUILDING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 S. 15TH ST.
GRAND JUNCTION CO
81501
US

IV. Provider business mailing address

205 S 15TH ST
GRAND JUNCTION CO
81501-4611
US

V. Phone/Fax

Practice location:
  • Phone: 970-241-2180
  • Fax: 970-241-0249
Mailing address:
  • Phone: 970-241-2180
  • Fax: 970-241-0249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number20161423
License Number StateCO

VIII. Authorized Official

Name: MR. B. DANIEL WASHINGTON
Title or Position: SECRETARY / TREASURER
Credential:
Phone: 970-241-2180