=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245613363
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARAGON HOME CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2015
-----------------------------------------------------
Last Update Date | 07/07/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1515 CHAIN BRIDGE RD SUITE 136
-----------------------------------------------------
City | MC LEAN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22101-4451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-942-8950
-----------------------------------------------------
Fax | 703-552-1345
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1515 CHAIN BRIDGE RD SUITE 136
-----------------------------------------------------
City | MC LEAN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22101-4451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-942-8950
-----------------------------------------------------
Fax | 703-552-1345
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CO-OWNER
-----------------------------------------------------
Name | MR. JUAN TUASON
-----------------------------------------------------
Credential | MBA
-----------------------------------------------------
Telephone | 703-942-8950
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HCO-151029
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------