MEDICARE: PHOENIX PLACE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1053128439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX PLACE

Provider Business Mailing Address
First Line	:	4 CECELIA DR
Second Line	:
City	:	AMELIA
State	:	OH
Zip	:	45102-1906
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 CECELIA DR
Second Line	:
City	:	AMELIA
State	:	OH
Zip	:	45102-1906
Country	:	US
Telephone Number	:	513-752-6170
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ZOE FISCUS DOSS
Credential	:
Telephone Number	:	513-752-6170

Provider Enumeration Date	:	12/18/2024
Last Update Date	:	12/18/2024

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Directions to “PHOENIX PLACE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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