Healthcare Provider Details

I. General information

NPI: 1134297153
Provider Name (Legal Business Name): PHOENIX HOUSES OF NEW YORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 11/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 W 74TH ST
NEW YORK NY
10023-2301
US

IV. Provider business mailing address

50 JAY ST 3RD FL
BROOKLYN NY
11201-1144
US

V. Phone/Fax

Practice location:
  • Phone: 718-222-6600
  • Fax: 718-576-2866
Mailing address:
  • Phone: 718-222-6600
  • Fax: 718-576-2866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. KEVIN KIRCHOFF
Title or Position: SR. VICE PRESIDENT
Credential:
Phone: 212-595-5810