Healthcare Provider Details

I. General information

NPI: 1750601480
Provider Name (Legal Business Name): PARAGON OUTPATIENT THERAPY SERVICES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2010
Last Update Date: 06/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7324 W CHEYENNE AVE SUITE 7
LAS VEGAS NV
89129-7427
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 702-214-6685
  • Fax: 702-214-6685
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: JERRY VELARDE
Title or Position: PRESIDENT
Credential:
Phone: 702-234-6685