PASA ALTA MANOR (NPI# 1336426717) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336426717 |
| Entity Type | Organization |
| Organization Name | PASA ALTA MANOR |
| Practice Address |
1790 N Fair Oaks Ave Pasadena CA 91103-1617 |
| Mailing Address |
Po Box 93577 Pasadena CA 91109-3577 |
| Practice Telephone | 6267986986 |
| Practice Fax Number | 6267985970 |
| Mailing Telephone | 6267986986 |
| Mailing Fax Number | 6267985970 |
| Enumeration Date | 2011-11-14 |
| Last Update Date | 2011-11-14 |
| Authorized Official Name | DEWALT BROWN (CEO) |
| Authorized Official Telephone | 6269263519 |
| Authorized Official Credential | MBA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 191222713 | CA | Residential Treatment Facilities |
| N | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 197600074 | CA | Residential Treatment Facilities |
| Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | 191204078 | CA | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | ADULT RESIDENTIAL FACILITY LICENSE NUMBER | 191204078 | 01 |
| CA | ADULT RESIDENTIAL FACILITY LICENSE NUMBER | 191222713 | 01 |
| CA | ADULT RESIDENTIAL FACILITY LICENSE NUMBER | 197600074 | 01 |
| Street Address |
1790 N FAIR OAKS AVE |
| City | PASADENA |
| State | CA |
| Zip Code | 91103-1617 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518143627 | Ricardo Johnson | Counselor | 1790 N Fair Oaks Ave, Pasadena, CA 91103-1617 | 2008-01-18 |
| 1356701452 | Nicole Jene Cuevas | Counselor | 1790 N Fair Oaks Ave, Pasadena, CA 91103-1617 | 2016-03-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013407071 | Sean Patrick Comingore | Counselor | 1680 N. Fair Oaks Ave., Pasadena, CA 91103 | 2018-05-15 |
| 1093230252 | John Jesus Smith | Rehabilitation Practitioner | 867 Fair Oaks Ave, Pasadena, CA 91103 | 2017-08-09 |
| 1760906085 | Roberto Sotelo Jr. | Licensed Vocational Nurse | 867 North Fair Oaks Ave., Pasadena, CA 91103 | 2017-07-28 |
| 1477076172 | Towana Danielle Hooks | Rehabilitation Practitioner | 867 North Fair Oaks, Pasadena, CA 91103 | 2017-07-25 |
| 1437671807 | Yolanda Centeno | Marriage & Family Therapist | 867 Fairoaks., Pasadena, CA 91103 | 2017-07-07 |
| 1306366604 | Joseph Anthony Zepeda | Counselor | 1680 N. Fair Oaks Avenue, Pasadena, CA 91103 | 2017-06-27 |
| 1922537372 | Chaznii Bradford | Licensed Vocational Nurse | 867 N. Fair Oaks, Pasadena, CA 91103 | 2017-06-08 |
| 1629505425 | Wassim Ammary | Pharmacist | 1855 South Fair Oaks Ave, Pasadena, CA 91103 | 2017-05-11 |
| 1679005920 | Grace Caroline Seto | Marriage & Family Therapist | 236 W. Mountain St, Suite 202d, Pasadena, CA 91103 | 2017-03-28 |
| 1225575293 | Catherine Lynn Gray | Psychologist | 30 North Raymond Avenue, Suite 403, Pasadena, CA 91103 | 2017-01-27 |
| Find all providers in zip 91103 | ||||
| Taxonomy Code | 320800000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment Facility, Mental Illness |
| A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891000360 | Robsag Inc. | Community Based Residential Treatment Facility, Mental Illness | 811 E Washington Blvd, Pasadena, CA 91104-5013 | 2010-08-09 |
| 1487218830 | Victor Treatment Centers, Inc. | Community Based Residential Treatment Facility, Mental Illness | 3244 E Green St, Pasadena, CA 91107-3836 | 2019-04-30 |
| 1639613821 | Hillsides | Community Based Residential Treatment Facility, Mental Illness | 940 Avenue 64, Pasadena, CA 91105-2711 | 2016-12-07 |
| 1689972846 | Rosemary Children's Services | Community Based Residential Treatment Facility, Mental Illness | 3244 E Green St, Pasadena, CA 91107-3836 | 2011-03-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
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| 1003417684 | A Better Life Recovery LLC | Community Based Residential Treatment Facility, Mental Illness | 1155 Hoover St, Carlsbad, CA 92008-4230 | 2020-11-02 |
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| 1467053041 | A Better Life Recovery LLC | Community Based Residential Treatment Facility, Mental Illness | 6477 Goldenbush Dr, Carlsbad, CA 92011-4203 | 2020-11-02 |
| 1366043937 | A Better Life Recovery LLC | Community Based Residential Treatment Facility, Mental Illness | 26065 Waterwheel Pl, Laguna Hills, CA 92653-6114 | 2020-11-02 |
| 1730780313 | Orchid Court, Inc. | Community Based Residential Treatment Facility, Mental Illness | 307 S Arrowhead Avenue, San Bernardino, CA 92408-1325 | 2020-11-02 |
| 1477151199 | Inspiring Pathways, Inc. | Community Based Residential Treatment Facility, Mental Illness | 1798 Bryman St, Hanford, CA 93230-7144 | 2020-10-14 |
| 1356949226 | Wings Recovery Center, Inc. | Community Based Residential Treatment Facility, Mental Illness | 3134 Morningside Dr, Oceanside, CA 92056-4401 | 2020-10-13 |
| 1326645904 | New Passages Group Home, Inc. | Community Based Residential Treatment Facility, Mental Illness | 5675 E Ashlan Ave, Fresno, CA 93727-7220 | 2020-10-06 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.