Healthcare Provider Details

I. General information

NPI: 1669514725
Provider Name (Legal Business Name): PHOENIX BRIDGE GROUP HOMES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3309 N NC HIGHWAY 49 # A
BURLINGTON NC
27217-8589
US

IV. Provider business mailing address

120 S MAIN ST
GRAHAM NC
27253-2808
US

V. Phone/Fax

Practice location:
  • Phone: 336-578-0540
  • Fax: 336-222-8533
Mailing address:
  • Phone: 336-222-8522
  • Fax: 336-222-8533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL 001-120
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL 001-100
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL 001-121
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL -001 - 135
License Number StateNC

VIII. Authorized Official

Name: MISS WENDY RENEE JONES
Title or Position: PROGRAM MANAGER
Credential:
Phone: 336-222-8522