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General NPI Number Information
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NPI Number | 1285680645
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Entity Type | Organization
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Legal Business Name | PHOENIX HEALTHCARE SERVICES LLC
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 04/09/2008
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Provider Practice Location Address
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Address Line | 7324 N WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60645-1814
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Country | US
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Telephone | 773-465-4555
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Fax | 773-465-4552
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Provider Business Mailing Address
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Address Line | 1941 GOVERNORS
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City | HOFFMAN ESTATES
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State | IL
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Zip | 60169
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Country | US
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Telephone | 847-310-3555
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Fax | 773-751-2225
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Authorized Official
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Title or Position | DELEGATED OFFICIAL
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Name | DR. JOEL MOSTOW
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Credential | MD
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Telephone | 773-465-4555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State | IL
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