Healthcare Provider Details

I. General information

NPI: 1912011974
Provider Name (Legal Business Name): PHOENIX SUN THERAPEUTIC SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 W CORNWALLIS DR STE M
GREENSBORO NC
27408-7015
US

IV. Provider business mailing address

2100 W CORNWALLIS DR STE M
GREENSBORO NC
27408-7015
US

V. Phone/Fax

Practice location:
  • Phone: 336-545-6890
  • Fax: 336-545-6892
Mailing address:
  • Phone: 336-545-6890
  • Fax: 336-545-6892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: MS. JOANNE L EURE
Title or Position: BILLING COORDINATOR
Credential:
Phone: 336-662-8185