MEDICARE: PARAGON OUTPATIENT THERAPY 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	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)		NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821162710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARAGON OUTPATIENT THERAPY SERVICES,LLC

Provider Business Mailing Address
First Line	:	1655 W. HORIZON RIDGE PKWY.
Second Line	:	SUITE 100
City	:	HENDERSON
State	:	NV
Zip	:	89012-3494
Country	:	US
Telephone Number	:	702-914-2790
Fax Number	:	702-914-5984

Provider Business Practice Location Address
First Line	:	1655 W. HORIZON RIDGE PKWY.
Second Line	:	SUITE 100
City	:	HENDERSON
State	:	NV
Zip	:	89012-3494
Country	:	US
Telephone Number	:	702-914-2790
Fax Number	:	702-914-5984

Authorized Official
Title or Position	:	CHIEF ADMINISTRATOR
Name	:	MRS. MICHELE VICTORIA MCKIERNAN
Credential	:	MHA
Telephone Number	:	702-914-2790

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	04/08/2011

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