Provider Demographics
NPI:1679917652
Name:PRINCIPLES INC.
Entity Type:Organization
Organization Name:PRINCIPLES INC.
Other - Org Name:IMPACT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:STILLWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-798-0884
Mailing Address - Street 1:1680 N FAIR OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-1642
Mailing Address - Country:US
Mailing Address - Phone:626-798-0884
Mailing Address - Fax:626-798-0679
Practice Address - Street 1:3217 N EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90032
Practice Address - Country:US
Practice Address - Phone:213-625-5009
Practice Address - Fax:213-625-5025
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRINCIPLES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-22
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1900948HN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility