MEDICARE: PHOENIX 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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1710819859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX HEALTH SERVICES

Provider Business Mailing Address
First Line	:	5610 PARK HEIGHTS AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21215-3928
Country	:	US
Telephone Number	:	443-878-1111
Fax Number	:

Provider Business Practice Location Address
First Line	:	5610 PARK HEIGHTS AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21215-3928
Country	:	US
Telephone Number	:	443-878-1111
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	NICOLE LIVELY
Credential	:
Telephone Number	:	443-878-1111

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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Directions to “PHOENIX HEALTH SERVICES ” Practice Location

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