NPIMap

Organization Active NPI

Pax House Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Altadena, CA
National Provider Identifier
1518455302
Registry record updated Jun 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
190732BP Issued in CA
Legal business name
PAX HOUSE INC.
Practice address
2052 Lake Ave Ste F
Altadena, CA 91001
Phone
(626) 808-0335
Fax
(626) 270-4640
NPI assigned
Apr 26, 2018
Organization subpart
Yes
Parent organization
PAX HOUSE INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 1, 2018

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

Authorized official

Name
Mr. Jordan Taylor Desimone, CADC-CASNPI 1932673563
Title
Program Director
Phone
(626) 808-0335

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 Use Disorder Rehabilitation Clinic/Center 261QR0405X 190732BP CA Primary

Addresses

Primary practice location

2052 Lake Ave Ste F
Altadena, CA 91001

Mailing address

1717 E Mendocino Street
Altadena, CA 91001
Phone (626) 398-3897

National Provider Directory

National Provider Directory
Tax ID family
Pax House Inc3 organizations share this tax ID, including this one
Part of
Pax House Inc

Other organizations with this tax ID 2

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 9

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": "1524700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527811200000",
    "number": "1518455302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 E MENDOCINO STREET",
            "city": "ALTADENA",
            "state": "CA",
            "postal_code": "91001",
            "telephone_number": "626-398-3897",
            "fax_number": "626-270-4640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2052 LAKE AVE STE F",
            "city": "ALTADENA",
            "state": "CA",
            "postal_code": "91001",
            "telephone_number": "626-808-0335",
            "fax_number": "626-270-4640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAX HOUSE INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PAX HOUSE INC.",
        "enumeration_date": "2018-04-26",
        "last_updated": "2018-06-01",
        "status": "A",
        "authorized_official_last_name": "DESIMONE",
        "authorized_official_first_name": "JORDAN",
        "authorized_official_middle_name": "TAYLOR",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "626-808-0335",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CADC-CAS"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "CA",
            "license": "190732BP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Altadena, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2018; 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.