Provider Demographics
NPI:1154106482
Name:PARAGON UC SUPPORT SERVICES, LLO
Entity type:Organization
Organization Name:PARAGON UC SUPPORT SERVICES, LLO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MIRJAFARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-406-2024
Mailing Address - Street 1:6746 WARD RD
Mailing Address - Street 2:
Mailing Address - City:NIAGRA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304
Mailing Address - Country:US
Mailing Address - Phone:716-622-2176
Mailing Address - Fax:
Practice Address - Street 1:77 E BRIDGE ST
Practice Address - Street 2:STE B
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126
Practice Address - Country:US
Practice Address - Phone:918-406-2024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness