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General NPI Number Information
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NPI Number | 1164021820
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Entity Type | Organization
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Legal Business Name | PHOENIX RECOVERY HOUSE
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Dates
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Enumeration Date | 10/22/2020
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Last Update Date | 10/22/2020
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Provider Practice Location Address
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Address Line | 109 S MAIN ST
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City | PLEASANTVILLE
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State | NJ
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Zip | 08232-2729
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Country | US
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Telephone | 610-350-9100
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Fax | 302-655-5317
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Provider Business Mailing Address
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Address Line | 611 WEIR RD
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City | ASTON
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State | PA
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Zip | 19014-1634
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Country | US
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Telephone | 610-350-9100
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Fax | 302-655-5317
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Authorized Official
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Title or Position | CEO
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Name | MR. WILLIAM GRAY MCKEE II
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Credential | FOUNDER/THERAPIST
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Telephone | 610-350-9100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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