Healthcare Provider Details

I. General information

NPI: 1598431728
Provider Name (Legal Business Name): THE PHOENIX PROJECT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7671 ABIGAIL GLEN DR
CHARLOTTE NC
28212-8643
US

IV. Provider business mailing address

7671 ABIGAIL GLEN DR
CHARLOTTE NC
28212-8643
US

V. Phone/Fax

Practice location:
  • Phone: 809-210-6099
  • Fax:
Mailing address:
  • Phone: 980-210-6099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: LINDA NANNETTE BAKER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 704-605-3465