=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174484596
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHOENIX REHABILITATION SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/24/2025
-----------------------------------------------------
Last Update Date | 11/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2184 S WILDERNESS RD
-----------------------------------------------------
City | MOUNT VERNON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40456-7631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-256-0000
-----------------------------------------------------
Fax | 606-256-0008
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2184 S WILDERNESS RD
-----------------------------------------------------
City | MOUNT VERNON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40456-7631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-256-0000
-----------------------------------------------------
Fax | 606-256-0008
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SOAHIL KHAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 606-256-0000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------