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NPI Code Detail

MEDICARE: PRINCIPLES INC (DBA) IMPACT DRUG & ALCOHOL TREATMENT CENTER

MEDICARE: PRINCIPLES INC (DBA) IMPACT DRUG & ALCOHOL TREATMENT CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1324500000XSubstance Abuse Rehabilitation Facility190094ANCA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11962542274OTHERCAMHN
21962542274OTHERCAMAGELLAN
31962542274OTHERCABLUE SHIELD
41962542274OTHERCAOPTUM
51962542274OTHERCAANTHEM BLUE CROSS

General Provider Information

NPI Number : 1962542274
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRINCIPLES INC (DBA) IMPACT DRUG & ALCOHOL TREATMENT CENTER
Provider Business Mailing Address
First Line : 1680 N FAIR OAKS AVE
Second Line :
City : PASADENA
State : CA
Zip : 91103-1642
Country : US
Telephone Number : 626-798-0884
Fax Number : 626-798-6970
Provider Business Practice Location Address
First Line : 1680 N FAIR OAKS AVE
Second Line :
City : PASADENA
State : CA
Zip : 91103-1642
Country : US
Telephone Number : 626-798-0884
Fax Number : 626-798-6970
Authorized Official
Title or Position : ADMISSIONS DIRECTOR
Name : MARK PAQUET
Credential : MBA, CAADE
Telephone Number : 626-798-0884
Provider Enumeration Date : 02/07/2007
Last Update Date : 06/14/2024

Similar Medicare Providers

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Practice Location Address:
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Practice Fax:
1669811618 — MRS. KRISTINA SCHROEDER NUNEZ CADC-CAS - T
Practice Location Address:
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PASADENA, CA
91103-1642
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Practice Fax:
1285021741 — MARK PAQUET MBA
Practice Location Address:
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PASADENA, CA
91103-1642
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1164819413 — LILAH PARRA
Practice Location Address:
1680 N FAIR OAKS AVE
PASADENA, CA
91103-1642
Practice Phone: 626-798-0884
Practice Fax: 626-798-6970

Directions to “PRINCIPLES INC (DBA) IMPACT DRUG & ALCOHOL TREATMENT CENTER ” Practice Location

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