Healthcare Provider Details

I. General information

NPI: 1407806615
Provider Name (Legal Business Name): PARADIGM SENIOR SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 E CAPITOL ST 840 TRUST MARK BUILDING
JACKSON MS
39201-2503
US

IV. Provider business mailing address

7431 114TH AVE SUITE 104
LARGO FL
33773-5119
US

V. Phone/Fax

Practice location:
  • Phone: 800-632-6074
  • Fax: 866-341-7509
Mailing address:
  • Phone: 800-632-6074
  • Fax: 866-341-7512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. KEVIN D HARWOOD
Title or Position: PRESIDENT/CEO
Credential:
Phone: 800-632-6074