MEDICARE: PAX TREATMENT CENTERS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility
2	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1144705914
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAX TREATMENT CENTERS LLC

Provider Business Mailing Address
First Line	:	4302 ROOSEVELT BLVD
Second Line	:
City	:	MIDDLETOWN
State	:	OH
Zip	:	45044-6625
Country	:	US
Telephone Number	:	513-433-1032
Fax Number	:	513-433-1245

Provider Business Practice Location Address
First Line	:	4302 ROOSEVELT BLVD
Second Line	:
City	:	MIDDLETOWN
State	:	OH
Zip	:	45044-6625
Country	:	US
Telephone Number	:	513-433-1032
Fax Number	:	513-433-1245

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	ANGIE NEWMAN
Credential	:
Telephone Number	:	337-582-2034

Provider Enumeration Date	:	09/27/2018
Last Update Date	:	09/27/2018

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