Healthcare Provider Details

I. General information

NPI: 1316370612
Provider Name (Legal Business Name): PARADIGM LIVING CONCEPTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2013
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8904 BASH ST STE B
INDIANAPOLIS IN
46256-1286
US

IV. Provider business mailing address

8904 BASH ST STE B
INDIANAPOLIS IN
46256-1286
US

V. Phone/Fax

Practice location:
  • Phone: 317-735-6001
  • Fax: 855-450-1177
Mailing address:
  • Phone: 317-735-6001
  • Fax: 855-450-1177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number13-013287-1
License Number StateIN

VIII. Authorized Official

Name: JEFFREY NOAH JARECKI
Title or Position: PRESIDENT/ CEO
Credential: MBA, HFA
Phone: 317-735-6001