Healthcare Provider Details

I. General information

NPI: 1174844179
Provider Name (Legal Business Name): PARAGON OF SUMMERLIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7324 W. CHEYENNE AVE SUITE 7
LAS VEGAS NV
89129-7426
US

IV. Provider business mailing address

7324 W. CHEYENNE AVE SUITE 7
LAS VEGAS NV
89129-7426
US

V. Phone/Fax

Practice location:
  • Phone: 702-214-6665
  • Fax: 702-214-6865
Mailing address:
  • Phone: 702-214-6665
  • Fax: 702-214-6865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2278P1005X
TaxonomyPulmonary Rehabilitation Certified Respiratory Therapist
License Number
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNV

VIII. Authorized Official

Name: SHAUN E. YATES
Title or Position: MANAGING PARTNER
Credential:
Phone: 702-214-6665