Healthcare Provider Details

I. General information

NPI: 1255052171
Provider Name (Legal Business Name): PARAMOUNT OPERATIONS BBD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2022
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 ISLAND DOCK RD
HADDAM CT
06438-1036
US

IV. Provider business mailing address

27 IROQUIS DR
MADISON TOWNSHIP PA
18444-4108
US

V. Phone/Fax

Practice location:
  • Phone: 321-917-0905
  • Fax:
Mailing address:
  • Phone: 856-418-7877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: KYLE BARTLER
Title or Position: CEO
Credential:
Phone: 321-917-0905