Axis Residential Treatment LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

330082AP Issued in CA

Legal business name

AXIS RESIDENTIAL TREATMENT LLC

Practice address

75450 Fairway Dr
Indian Wells, CA 92210-8421

Phone

(760) 469-8275

Fax

(760) 346-8032

NPI assigned

Apr 19, 2007

Last updated

Jul 31, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Brad T Keith, CCDC CAD CA

Title

Ceo

Phone

(310) 435-6298

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217462400000",
    "number": "1710104807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75450 FAIRWAY DR",
            "city": "INDIAN WELLS",
            "state": "CA",
            "postal_code": "922108421",
            "telephone_number": "760-469-8275",
            "fax_number": "760-346-8032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75450 FAIRWAY DR",
            "city": "INDIAN WELLS",
            "state": "CA",
            "postal_code": "922108421",
            "telephone_number": "760-469-8275",
            "fax_number": "760-346-8032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AXIS RESIDENTIAL TREATMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-19",
        "last_updated": "2008-07-31",
        "status": "A",
        "authorized_official_last_name": "KEITH",
        "authorized_official_first_name": "BRAD",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "310-435-6298",
        "authorized_official_credential": "CCDC CAD CA"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "330082AP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Substance Abuse Rehabilitation Facility in Indian Wells, CA
• Providers in Indian Wells, CA by specialty
• Substance Abuse Rehabilitation Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2008; 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.