Healthcare Provider Details

I. General information

NPI: 1588129738
Provider Name (Legal Business Name): PARADIGM HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2019
Last Update Date: 02/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 OBSERVATORY DR
BEAR DE
19701-6835
US

IV. Provider business mailing address

709 OBSERVATORY DR
BEAR DE
19701-6835
US

V. Phone/Fax

Practice location:
  • Phone: 301-233-7221
  • Fax:
Mailing address:
  • Phone: 301-233-7221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHISA HARRIS
Title or Position: CEO
Credential:
Phone: 301-233-7221