Provider Demographics
NPI:1497572218
Name:PAX RECOVERY CENTER LLC
Entity type:Organization
Organization Name:PAX RECOVERY CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-544-9332
Mailing Address - Street 1:436 S 7TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203-1981
Mailing Address - Country:US
Mailing Address - Phone:714-786-5227
Mailing Address - Fax:
Practice Address - Street 1:436 S 7TH ST STE 100
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-1981
Practice Address - Country:US
Practice Address - Phone:714-786-5227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-23
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty