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General NPI Number Information
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NPI Number | 1053128439
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Entity Type | Organization
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Legal Business Name | PHOENIX PLACE
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Dates
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Enumeration Date | 12/18/2024
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 4 CECELIA DR
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City | AMELIA
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State | OH
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Zip | 45102-1906
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Country | US
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Telephone | 513-752-6170
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Fax |
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Provider Business Mailing Address
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Address Line | 4 CECELIA DR
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City | AMELIA
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State | OH
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Zip | 45102-1906
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ZOE FISCUS DOSS
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Credential |
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Telephone | 513-752-6170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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