Healthcare Provider Details

I. General information

NPI: 1053263111
Provider Name (Legal Business Name): PHOENIX HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2026
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 TORINGDON WAY STE 200
CHARLOTTE NC
28277-4650
US

IV. Provider business mailing address

3540 TORINGDON WAY STE 200
CHARLOTTE NC
28277-4650
US

V. Phone/Fax

Practice location:
  • Phone: 704-713-2444
  • Fax:
Mailing address:
  • Phone: 704-713-2444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: ELONZO STROUD
Title or Position: OWNER
Credential:
Phone: 646-420-0019