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General NPI Number Information
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NPI Number | 1598477457
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Entity Type | Organization
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Legal Business Name | PHOENIX RESIDENTIAL INVESTMENT GROUP
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Dates
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Enumeration Date | 12/21/2022
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Last Update Date | 03/20/2026
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Provider Practice Location Address
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Address Line | 127 WILSON RD
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City | WAXAHACHIE
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State | TX
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Zip | 75165-9185
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Country | US
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Telephone | 214-301-8900
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Fax |
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Provider Business Mailing Address
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Address Line | 608 CHAPEL PL
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City | CEDAR HILL
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State | TX
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Zip | 75104-1760
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Country | US
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Telephone | 214-301-8900
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Fax |
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Authorized Official
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Title or Position | PROGRAM ADMINISTRATOR
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Name | DR. DETITRIA MUTIZWA
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Credential |
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Telephone | 214-301-8900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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