Provider Demographics
NPI:1649307869
Name:THE PAJO CORPORATION
Entity type:Organization
Organization Name:THE PAJO CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:323-242-0500
Mailing Address - Street 1:11900 AVALON BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90061-2837
Mailing Address - Country:US
Mailing Address - Phone:323-242-0500
Mailing Address - Fax:323-242-0600
Practice Address - Street 1:11900 AVALON BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90061-2837
Practice Address - Country:US
Practice Address - Phone:323-242-0500
Practice Address - Fax:323-242-0600
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE PAJO CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-27
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19.151261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHDC70115FMedicaid