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General NPI Number Information
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NPI Number | 1619450186
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Entity Type | Organization
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Legal Business Name | PAX HOUSE INC.
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Dates
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Enumeration Date | 09/11/2018
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Last Update Date | 09/11/2018
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Provider Practice Location Address
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Address Line | 2305 HURSTBOURNE VILLAGE DR STE 600
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City | LOUISVILLE
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State | KY
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Zip | 40299-2875
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Country | US
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Telephone | 626-840-0111
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Fax | 626-270-4640
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Provider Business Mailing Address
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Address Line | 2305 HURSTBOURNE VILLAGE DR STE 600
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City | LOUISVILLE
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State | KY
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Zip | 40299-2875
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Country | US
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Telephone | 626-840-0111
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Fax | 626-270-4640
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MR. JORDAN T. DESIMONE
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Credential | CADC-CAS
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Telephone | 626-808-0335
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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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