MEDICARE: PARAMOUNT OPERATIONS BBD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility
2	276400000X	Substance Use Disorder Rehabilitation Hospital Unit

General Provider Information

NPI Number	:	1255052171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARAMOUNT OPERATIONS BBD LLC

Provider Business Mailing Address
First Line	:	27 IROQUIS DR
Second Line	:
City	:	MADISON TOWNSHIP
State	:	PA
Zip	:	18444-4108
Country	:	US
Telephone Number	:	856-418-7877
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 ISLAND DOCK RD
Second Line	:
City	:	HADDAM
State	:	CT
Zip	:	06438-1036
Country	:	US
Telephone Number	:	321-917-0905
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KYLE BARTLER
Credential	:
Telephone Number	:	321-917-0905

Provider Enumeration Date	:	09/08/2022
Last Update Date	:	06/05/2024

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