MEDICARE: PARADIGM REHAB & NURSING, 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	251E00000X	Home Health Agency	009541	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	009541	OTHER	TX	STATE HHA LICENSE NUMBER

General Provider Information

NPI Number	:	1376540047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARADIGM REHAB & NURSING, LLC

Provider Business Mailing Address
First Line	:	PO BOX 130010
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75713-0010
Country	:	US
Telephone Number	:	903-581-1223
Fax Number	:

Provider Business Practice Location Address
First Line	:	2269 W CUMBERLAND RD STE 100
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703-5482
Country	:	US
Telephone Number	:	903-581-1223
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DANIEL ROBERT WILLSON
Credential	:
Telephone Number	:	903-581-1223

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	04/24/2026

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