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General NPI Number Information
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NPI Number | 1306305727
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Entity Type | Organization
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Legal Business Name | RED PHOENIX HEALING LLC
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Dates
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Enumeration Date | 03/15/2019
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Last Update Date | 05/14/2020
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Provider Practice Location Address
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Address Line | 89 MAIN ST STE 304
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City | MEDWAY
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State | MA
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Zip | 02053-1815
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Country | US
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Telephone | 774-573-1644
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Fax | 774-233-0037
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Provider Business Mailing Address
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Address Line | 89 MAIN ST STE 304
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City | MEDWAY
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State | MA
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Zip | 02053-1815
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Country | US
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Telephone | 774-573-1644
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Fax | 774-233-0037
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Authorized Official
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Title or Position | OWNER
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Name | CYNTHIA MEESKE
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Credential | LICSW
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Telephone | 774-573-1644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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