Provider Demographics
NPI:1477786226
Name:PARAGON HEALTHCARE OF ARIZONA,LLC.
Entity type:Organization
Organization Name:PARAGON HEALTHCARE OF ARIZONA,LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:W
Authorized Official - Last Name:SPEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:924-444-8168
Mailing Address - Street 1:2585 MIRACLE MILE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-7522
Mailing Address - Country:US
Mailing Address - Phone:928-444-8168
Mailing Address - Fax:928-444-8169
Practice Address - Street 1:2585 S MIRACLE MILE
Practice Address - Street 2:SUITE 107
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7522
Practice Address - Country:US
Practice Address - Phone:928-444-8168
Practice Address - Fax:928-444-8169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonaryGroup - Multi-Specialty
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ141280OtherMEDICARE PTAN
AZ034526Medicare Oscar/Certification