Healthcare Provider Details

I. General information

NPI: 1821162710
Provider Name (Legal Business Name): PARAGON OUTPATIENT THERAPY SERVICES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 04/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 W. HORIZON RIDGE PKWY. SUITE 100
HENDERSON NV
89012-3494
US

IV. Provider business mailing address

1655 W. HORIZON RIDGE PKWY. SUITE 100
HENDERSON NV
89012-3494
US

V. Phone/Fax

Practice location:
  • Phone: 702-914-2790
  • Fax: 702-914-5984
Mailing address:
  • Phone: 702-914-2790
  • Fax: 702-914-5984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number StateNV

VIII. Authorized Official

Name: MRS. MICHELE VICTORIA MCKIERNAN
Title or Position: CHIEF ADMINISTRATOR
Credential: MHA
Phone: 702-914-2790