MEDICARE: PARADIGM RECOVERY GROUP 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	251B00000X	Case Management Agency	06463665	CA
2	251S00000X	Community/Behavioral Health Agency	06463665	CA
3	261QH0100X	Health Service Clinic/Center	06463665	CA
4	261QM0850X	Adult Mental Health Clinic/Center	06463665	CA
5	261QM1300X	Multi-Specialty Clinic/Center	06463665	CA
6	261QP2000X	Physical Therapy Clinic/Center	06463665	CA
7	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	06463665	CA
8	3245S0500X	Children's Substance Abuse Rehabilitation Facility	06463665	CA
9	261QP3300X	Pain Clinic/Center	06463665	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	N/A	OTHER	CA	N/A

General Provider Information

NPI Number	:	1801327663
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARADIGM RECOVERY GROUP LLC

Provider Business Mailing Address
First Line	:	601 E DAILY DR STE 205
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93010-5839
Country	:	US
Telephone Number	:	184-438-8410
Fax Number	:	180-591-4063

Provider Business Practice Location Address
First Line	:	601 E DAILY DR STE 205
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93010-5839
Country	:	US
Telephone Number	:	184-438-8410
Fax Number	:	180-591-4063

Authorized Official
Title or Position	:	CEO
Name	:	MR. JOHN CARL STENZEL
Credential	:
Telephone Number	:	184-438-8411

Provider Enumeration Date	:	03/23/2017
Last Update Date	:	03/23/2017

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