Provider Demographics
NPI:1093183972
Name:PAX CAMPUS, LLC
Entity Type:Organization
Organization Name:PAX CAMPUS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FREDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-859-3185
Mailing Address - Street 1:508 LUCERNE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-3819
Mailing Address - Country:US
Mailing Address - Phone:844-406-8956
Mailing Address - Fax:
Practice Address - Street 1:508 LUCERNE AVE
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-3819
Practice Address - Country:US
Practice Address - Phone:844-406-8956
Practice Address - Fax:866-239-7439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder