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General NPI Number Information
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NPI Number | 1659136695
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Entity Type | Organization
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Legal Business Name | PHOENIX HEALTH SERVICES
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Dates
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Enumeration Date | 02/19/2024
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 3802 W ROGERS AVE
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City | BALTIMORE
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State | MD
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Zip | 21215-4528
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Country | US
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Telephone | 443-878-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 5616 PARK HEIGHTS AVE
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City | BALTIMORE
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State | MD
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Zip | 21215-3969
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Country | US
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Telephone | 443-878-1111
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Fax |
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Authorized Official
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Title or Position | COO
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Name | NICOLE LIVELY
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Credential |
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Telephone | 443-631-3303
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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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