MEDICARE: PHOENIX CENTER BEHAVIORAL HEALTH SERVICES

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	320800000X	Mental Illness Community Based Residential Treatment Facility		GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649424789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX CENTER BEHAVIORAL HEALTH SERVICES

Provider Business Mailing Address
First Line	:	940 HIGHWAY 96 STE A
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-2587
Country	:	US
Telephone Number	:	478-988-1222
Fax Number	:	478-988-1422

Provider Business Practice Location Address
First Line	:	940 HIGHWAY 96 STE A
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-2587
Country	:	US
Telephone Number	:	478-988-1222
Fax Number	:	478-988-1422

Authorized Official
Title or Position	:	LPN
Name	:	SHONTAON MICHELLE DEAN
Credential	:
Telephone Number	:	478-988-1222

Provider Enumeration Date	:	11/14/2008
Last Update Date	:	07/21/2022

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Directions to “PHOENIX CENTER BEHAVIORAL HEALTH SERVICES ” Practice Location

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