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General NPI Number Information
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NPI Number | 1508992249
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Entity Type | Organization
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Legal Business Name | PHOENIX HOUSES OF TEXAS, INC
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 12/20/2022
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Provider Practice Location Address
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Address Line | 2345 REAGAN ST
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City | DALLAS
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State | TX
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Zip | 75219-3225
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Country | US
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Telephone | 214-999-1044
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Fax | 214-526-3285
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Provider Business Mailing Address
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Address Line | 1910 PACIFIC AVE STE 10500
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City | DALLAS
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State | TX
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Zip | 75201-4591
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Country | US
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Telephone | 214-920-1628
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Fax | 214-351-0967
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | MR. BART R LOEWEN
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Credential |
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Telephone | 214-920-1628
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 865
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License Number State | TX
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