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General NPI Number Information
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NPI Number | 1336654854
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Entity Type | Organization
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Legal Business Name | PHOENIX GROUP HOME, LLC
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Dates
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Enumeration Date | 12/06/2017
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Last Update Date | 02/06/2026
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Provider Practice Location Address
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Address Line | 3012 GLENMORE AVE STE 104
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City | CINCINNATI
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State | OH
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Zip | 45238-2258
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Country | US
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Telephone | 740-858-1659
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Fax | 740-876-9213
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Provider Business Mailing Address
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Address Line | 3012 GLENMORE AVE STE 104
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City | CINCINNATI
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State | OH
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Zip | 45238-2258
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Country | US
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Telephone | 740-858-1659
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Fax | 740-876-9213
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | ABBIE CARPENTER
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Credential |
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Telephone | 304-794-6285
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #2
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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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