Provider Demographics
NPI:1861549149
Name:PARAGON OUTPATIENT THERAPY SERVICES LLC
Entity type:Organization
Organization Name:PARAGON OUTPATIENT THERAPY SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKIERNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:702-914-2790
Mailing Address - Street 1:1655 W HORIZON RIDGE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-3494
Mailing Address - Country:US
Mailing Address - Phone:702-914-2790
Mailing Address - Fax:702-914-5984
Practice Address - Street 1:1470 W CALVADA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-5869
Practice Address - Country:US
Practice Address - Phone:775-537-2300
Practice Address - Fax:775-537-2345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV294510Medicare PIN