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General NPI Number Information
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NPI Number | 1154979615
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Entity Type | Organization
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Legal Business Name | PAX RIVERBEND LLC
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Dates
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Enumeration Date | 08/28/2019
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Last Update Date | 03/11/2024
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Provider Practice Location Address
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Address Line | 202 E MAPLE ST
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-3420
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Country | US
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Telephone | 815-250-5006
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Fax |
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Provider Business Mailing Address
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Address Line | 10461 MILL RUN CIR STE 810
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City | OWINGS MILLS
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State | MD
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Zip | 21117-5549
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF COMPLIANCE
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Name | KIM BROWN
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Credential |
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Telephone | 870-243-7219
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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