| Pax Recovery Center Llc | |
|
436 S 7th St Ste 100 Louisville KY 40203-1981 | |
| (714) 786-5227 | |
| Not Available |
| Full Name | Pax Recovery Center Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 436 S 7th St Ste 100, Louisville, Kentucky |
| Authorized Official Name and Position | Jessica Burden (OWNER) |
| Authorized Official Contact | 5025449332 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pax Recovery Center Llc 436 S 7th St Ste 100 Louisville KY 40203-1981 Ph: (714) 786-5227 | Pax Recovery Center Llc 436 S 7th St Ste 100 Louisville KY 40203-1981 Ph: (714) 786-5227 |
| NPI Number | 1497572218 |
|---|---|
| Provider Enumeration Date | 09/23/2024 |
| Last Update Date | 01/24/2025 |
| Certification Date | 01/24/2025 |
| Medicare PECOS PAC ID | 1254851017 |
|---|---|
| Medicare Enrollment ID | O20250224001415 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497572218 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Roberto A Penne-casanova |
|---|---|
| Provider Type | Practitioner - Preventive Medicine |
| Provider Identifiers | NPI Number: 1265492748 PECOS PAC ID: 4880581164 Enrollment ID: I20101119000610 |
| Provider Name | Alisha Renee Ward |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1790983013 PECOS PAC ID: 5294264974 Enrollment ID: I20250124001505 |
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