Healthcare Provider Details

I. General information

NPI: 1609351477
Provider Name (Legal Business Name): PAX TREATMENT CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2018
Last Update Date: 03/25/2020
Certification Date: 03/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 ROOSEVELT BLVD
MIDDLETOWN OH
45044-6625
US

IV. Provider business mailing address

4302 ROOSEVELT BLVD
MIDDLETOWN OH
45044-6625
US

V. Phone/Fax

Practice location:
  • Phone: 513-433-1032
  • Fax: 513-433-1245
Mailing address:
  • Phone: 513-433-1032
  • Fax: 513-433-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: ANGIE NEWMAN
Title or Position: BILLING MANAGER
Credential:
Phone: 337-582-2034