Provider Demographics
NPI:1619450186
Name:PAX HOUSE INC.
Entity Type:Organization
Organization Name:PAX HOUSE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:DESIMONE
Authorized Official - Suffix:
Authorized Official - Credentials:CADC-CAS
Authorized Official - Phone:626-808-0335
Mailing Address - Street 1:2305 HURSTBOURNE VILLAGE DR STE 600
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-2875
Mailing Address - Country:US
Mailing Address - Phone:626-840-0111
Mailing Address - Fax:626-270-4640
Practice Address - Street 1:2305 HURSTBOURNE VILLAGE DR STE 600
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-2875
Practice Address - Country:US
Practice Address - Phone:626-840-0111
Practice Address - Fax:626-270-4640
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAX HOUSE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder