MEDICARE: PARAGON OUTPATIENT REHABILITATION SERVICES, 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	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1518741875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARAGON OUTPATIENT REHABILITATION SERVICES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 74590
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44194-0002
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	602 BREVARD ST
Second Line	:
City	:	KINGS MOUNTAIN
State	:	NC
Zip	:	28086-8692
Country	:	US
Telephone Number	:	980-224-5253
Fax Number	:

Authorized Official
Title or Position	:	SVP & CHIEF LEGAL OFFICER
Name	:	CRISTINA PIETROWSKI
Credential	:
Telephone Number	:	502-412-5847

Provider Enumeration Date	:	08/18/2023
Last Update Date	:	11/21/2023

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