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General NPI Number Information
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NPI Number | 1154592525
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Entity Type | Organization
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Legal Business Name | PHOENIX RISING BEHAVIORAL HEALTHCARE AND RECOVERY, INC
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Dates
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Enumeration Date | 03/13/2008
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Last Update Date | 03/13/2008
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Provider Practice Location Address
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Address Line | 1930 FREMONT PL SW
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City | CANTON
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State | OH
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Zip | 44706-1551
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Country | US
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Telephone | 330-455-5950
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Fax |
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Provider Business Mailing Address
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Address Line | 1930 FREMONT PL SW
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City | CANTON
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State | OH
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Zip | 44706-1551
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Country | US
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Telephone | 330-455-5950
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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 | MS. LISA K GRUBBS
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Credential | LPCC
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Telephone | 330-455-5950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | 573
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License Number State | OH
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