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General NPI Number Information
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NPI Number | 1235472721
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Entity Type | Organization
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Legal Business Name | ELIJAH'S HOUSE TX CORP
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Dates
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Enumeration Date | 04/03/2013
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 1408 N HILL AVE
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City | PASADENA
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State | CA
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Zip | 91104-2614
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Country | US
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Telephone | 833-805-4544
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Fax | 626-517-5005
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Provider Business Mailing Address
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Address Line | 1408 N HILL AVE
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City | PASADENA
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State | CA
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Zip | 91104-2614
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Country | US
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Telephone | 909-636-8854
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Fax | 626-389-4110
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Authorized Official
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Title or Position | CEO
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Name | PAMELA MCCOY
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Credential |
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Telephone | 626-798-1340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 190769AP
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License Number State | CA
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