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General NPI Number Information
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NPI Number | 1568389948
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Entity Type | Organization
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Legal Business Name | PAX RESIDENTIAL LLC
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Dates
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Enumeration Date | 07/06/2026
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Last Update Date | 07/06/2026
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Provider Practice Location Address
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Address Line | 1420 SPRING ST
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-3740
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Country | US
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Telephone | 812-260-1177
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Fax | 812-410-4329
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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 | 410-807-8471
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Fax | 410-525-5560
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Authorized Official
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Title or Position | LICENSING AND CREDENITALING
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Name | GINNY SHAFFER
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Credential | CPCS
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Telephone | 765-225-8298
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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 |
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License Number State |
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