NPIMap

Organization Active NPI

Principles Inc (Dba) Impact Drug & Alcohol Treatment Center

Doing business as Impact Outpatient

  • Substance Abuse Rehabilitation Facility
  • Pasadena, CA
National Provider Identifier
1497196075
Registry record updated Jun 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
190094GN Issued in CA
Legal business name
PRINCIPLES INC (DBA) IMPACT DRUG & ALCOHOL TREATMENT CENTER
Doing business as
Impact Outpatient
Practice address
1450 N Lake Ave
2ND Floor
Pasadena, CA 91104-2301
Phone
(626) 564-4240
Fax
(626) 577-4250
NPI assigned
Jul 11, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Miss Christina GonzalesNPI 1861866220
Title
Executive Director
Phone
(626) 798-0884

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X 190094GN CA Primary

Addresses

Primary practice location

1450 N Lake Ave
2ND Floor
Pasadena, CA 91104-2301

Mailing address

1450 N Lake Ave
2ND Floor
Pasadena, CA 91104-2301
Phone (626) 564-4240

Other names 1

  • Impact Outpatient Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Principles Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1450 N Lake Ave
Fl 2
Pasadena, CA 91104
Phone (626) 564-4240

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1373500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718323200000",
    "number": "1497196075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1450 N LAKE AVE",
            "address_2": "2ND FLOOR",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911042301",
            "telephone_number": "626-564-4240",
            "fax_number": "626-577-4250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 N LAKE AVE",
            "address_2": "2ND FLOOR",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911042301",
            "telephone_number": "626-564-4240",
            "fax_number": "626-577-4250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRINCIPLES INC (DBA) IMPACT DRUG & ALCOHOL TREATMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-11",
        "last_updated": "2024-06-14",
        "certification_date": "2024-06-14",
        "status": "A",
        "authorized_official_last_name": "GONZALES",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "626-798-0884",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "190094GN",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Impact Outpatient",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pasadena, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.