Healthcare Provider Details

I. General information

NPI: 1275938193
Provider Name (Legal Business Name): PHOENIX BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 WHITEHEAD ROAD EXT
EWING NJ
08638-2406
US

IV. Provider business mailing address

1014 WHITEHEAD ROAD EXT
EWING NJ
08638-2406
US

V. Phone/Fax

Practice location:
  • Phone: 609-771-3777
  • Fax: 609-771-8041
Mailing address:
  • Phone: 609-771-3777
  • Fax: 609-771-8041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNJ

VIII. Authorized Official

Name: MR. URIEL FELDMAN
Title or Position: EXECUTIVE DIRECTOR
Credential: LSW
Phone: 732-581-6067