Provider Demographics
NPI:1679924666
Name:PARAGON RECOVERY LLC
Entity type:Organization
Organization Name:PARAGON RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHALYCE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:LIKENS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:949-572-5175
Mailing Address - Street 1:1852 SANTA MARGARITA DR
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-1643
Mailing Address - Country:US
Mailing Address - Phone:760-731-1386
Mailing Address - Fax:
Practice Address - Street 1:1852 SANTA MARGARITA DR
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-1643
Practice Address - Country:US
Practice Address - Phone:760-731-1386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility