Provider Demographics
NPI:1720840937
Name:PARAGON HOSPICE AGENCY LLC
Entity type:Organization
Organization Name:PARAGON HOSPICE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAMEERA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFIQ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:734-301-5646
Mailing Address - Street 1:2420 N COLISEUM BLVD STE 201B
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-3139
Mailing Address - Country:US
Mailing Address - Phone:260-493-6050
Mailing Address - Fax:260-492-7771
Practice Address - Street 1:2420 N COLISEUM BLVD STE 201B
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-3139
Practice Address - Country:US
Practice Address - Phone:260-493-6050
Practice Address - Fax:260-492-7771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-24
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based