Provider Demographics
NPI:1649545393
Name:PASADENA COUNCIL ON ALCOHOLISM AND DRUG DEPENDENCE
Entity type:Organization
Organization Name:PASADENA COUNCIL ON ALCOHOLISM AND DRUG DEPENDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FELIPE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KAISER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-795-9127
Mailing Address - Street 1:1245 EAST WALNUT STREET
Mailing Address - Street 2:SUITE 117
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106
Mailing Address - Country:US
Mailing Address - Phone:626-795-9127
Mailing Address - Fax:626-795-0979
Practice Address - Street 1:1245 E WALNUT ST
Practice Address - Street 2:SUITE 117
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1878
Practice Address - Country:US
Practice Address - Phone:626-795-9127
Practice Address - Fax:626-795-0979
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOCIAL MODEL RECOVERY SYSTEMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-14
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7642OtherMEDICAL