Healthcare Provider Details

I. General information

NPI: 1437213634
Provider Name (Legal Business Name): PHOENIX PROGRAMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 E LESLIE LN
COLUMBIA MO
65202-1535
US

IV. Provider business mailing address

90 E LESLIE LN
COLUMBIA MO
65202-1535
US

V. Phone/Fax

Practice location:
  • Phone: 573-875-8880
  • Fax:
Mailing address:
  • Phone: 573-875-8880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH BESTE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 573-875-8880