Paragon Rehab, LLC

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT1197 Issued in MS

Legal business name

PARAGON REHAB, LLC

Practice address

323 Industrial Park
Liberty, MS 39645-8069

Phone

(601) 657-1000

Fax

(601) 657-9121

NPI assigned

Mar 31, 2011

Organization subpart

Yes

Parent organization

CLC OF LIBERTY, LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sally McCoy

Title

Administrator

Phone

(601) 657-1000

Specialties & licenses 1

Addresses

Other identifiers 1

Part of

CLC of Liberty LLC

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• CLC of Liberty, LLC

  • Skilled Nursing Facility
  • Liberty, MS
  • NPI 1912997685
  NPPES parent name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1301529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301529600000",
    "number": "1124317060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "323 INDUSTRIAL PARK DR",
            "city": "LIBERTY",
            "state": "MS",
            "postal_code": "39645",
            "telephone_number": "601-657-1000",
            "fax_number": "601-657-9121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "323 INDUSTRIAL PARK",
            "city": "LIBERTY",
            "state": "MS",
            "postal_code": "396458069",
            "telephone_number": "601-657-1000",
            "fax_number": "601-657-9121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARAGON REHAB, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CLC OF LIBERTY, LLC",
        "enumeration_date": "2011-03-31",
        "last_updated": "2011-03-31",
        "status": "A",
        "authorized_official_last_name": "MCCOY",
        "authorized_official_first_name": "SALLY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "601-657-1000"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "MS",
            "license": "OT1197",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00230121",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Evelyn Jeanette Love, MA
• Trinity McKenzie, M.D.
• Mississippi State Department of Health
• Leslie Odom
• Hannah Page
• Paragon Rehab, LLC
• Paragon Rehab, LLC
• Catherine Roberts, FNP
• Melanie Dawne Robertson, FNP-C
• Karen Christine Ross, FNP

• All providers in Liberty, MS
• Occupational Therapist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.