Healthcare Provider Details

I. General information

NPI: 1235472721
Provider Name (Legal Business Name): ELIJAH'S HOUSE TX CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 N HILL AVE
PASADENA CA
91104-2614
US

IV. Provider business mailing address

1408 N HILL AVE
PASADENA CA
91104-2614
US

V. Phone/Fax

Practice location:
  • Phone: 833-805-4544
  • Fax: 626-517-5005
Mailing address:
  • Phone: 909-636-8854
  • Fax: 626-389-4110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number190769AP
License Number StateCA

VIII. Authorized Official

Name: PAMELA MCCOY
Title or Position: CEO
Credential:
Phone: 626-798-1340