Healthcare Provider Details

I. General information

NPI: 1811240344
Provider Name (Legal Business Name): PARADIGM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2012
Last Update Date: 10/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4558 REEDY BRANCH RD
WINTERVILLE NC
28590-8925
US

IV. Provider business mailing address

PO BOX 31091
GREENVILLE NC
27833-1091
US

V. Phone/Fax

Practice location:
  • Phone: 252-561-8112
  • Fax: 252-561-7455
Mailing address:
  • Phone: 252-561-8112
  • Fax: 252-561-7455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHL098180
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberMHL-098-180
License Number StateNC

VIII. Authorized Official

Name: JASON BARNETT
Title or Position: CEO
Credential: RN
Phone: 252-561-8112