Healthcare Provider Details

I. General information

NPI: 1841109139
Provider Name (Legal Business Name): PHOENIX PATHWAYS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 MOUNT JOY ST
SPRINGFIELD OH
45505-2623
US

IV. Provider business mailing address

340 MOUNT JOY ST
SPRINGFIELD OH
45505-2623
US

V. Phone/Fax

Practice location:
  • Phone: 937-408-3165
  • Fax:
Mailing address:
  • Phone: 937-408-3165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANGELINA BARKER MULLINS
Title or Position: OWNER
Credential: CDCA
Phone: 937-408-3165