Provider Demographics
NPI:1962542274
Name:PRINCIPLES INC (DBA) IMPACT DRUG & ALCOHOL TREATMENT CENTER
Entity type:Organization
Organization Name:PRINCIPLES INC (DBA) IMPACT DRUG & ALCOHOL TREATMENT CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMISSIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:PAQUET
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, CAADE
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:626-798-6970
Practice Address - Street 1:1680 N FAIR OAKS AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-1642
Practice Address - Country:US
Practice Address - Phone:626-798-0884
Practice Address - Fax:626-798-6970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190094AN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1962542274OtherMHN
CA1962542274OtherMAGELLAN
CA1962542274OtherBLUE SHIELD
CA1962542274OtherOPTUM
CA1962542274OtherANTHEM BLUE CROSS