Provider Demographics
NPI:1235986431
Name:PARAGON MEDICAL & THERAPEUTIC SERVICES OF OHIO
Entity type:Organization
Organization Name:PARAGON MEDICAL & THERAPEUTIC SERVICES OF OHIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:KING
Authorized Official - Suffix:JR
Authorized Official - Credentials:LSATP
Authorized Official - Phone:757-713-0385
Mailing Address - Street 1:303 MEADOWLAKE RD
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-3617
Mailing Address - Country:US
Mailing Address - Phone:757-713-0385
Mailing Address - Fax:
Practice Address - Street 1:7400 JUSTICE DR STE 327
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-6146
Practice Address - Country:US
Practice Address - Phone:757-528-5807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-04
Last Update Date:2024-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty