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1659136695 NPI number — PHOENIX HEALTH SERVICES

NPI Number: 1659136695
Health Care Provider/Practitioner: PHOENIX HEALTH SERVICES

Information about “1659136695” NPI (PHOENIX HEALTH SERVICES) exists in 1659136695 in HTML format HTML  |  1659136695 in plain Text format TXT  |  1659136695 in PDF (Portable Document Format) PDF  |  1659136695 in an XML format XML  formats.

NPI Number : 1659136695 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1659136695",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PHOENIX HEALTH SERVICES",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5616 PARK HEIGHTS AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BALTIMORE",
    "MailingAddressStateName": "MD",
    "MailingAddressPostalCode": "21215-3969",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "443-878-1111",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3802 W ROGERS AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BALTIMORE",
    "PracticeLocationAddressStateName": "MD",
    "PracticeLocationAddressPostalCode": "21215-4528",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "443-878-1111",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/19/2024",
    "LastUpdateDate": "02/05/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "LIVELY",
    "AuthorizedOfficialFirstName": "NICOLE",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "COO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "443-631-3303",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QR0405X",
        "TaxonomyName": "Substance Use Disorder Rehabilitation Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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