Basic Information
| Provider Information | |||||||||
| NPI: | 1861517088 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PARADIGM, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 31091 | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278331091 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2525618112 | ||||||||
| FaxNumber: | 2525617455 | ||||||||
| Practice Location | |||||||||
| Address1: | 4001 OLD PACTOLUS RD # A | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278340701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2525618112 | ||||||||
| FaxNumber: | 2525617455 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 09/10/2007 | ||||||||
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| AuthorizedOfficialLastName: | BARNETT | ||||||||
| AuthorizedOfficialFirstName: | JASON | ||||||||
| AuthorizedOfficialMiddleName: | TREMAIN | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2527141230 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | MHL-074-136 | NC | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 8301107 | 05 | NC | MEDICAID |