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General NPI Number Information
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NPI Number | 1669514725
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Entity Type | Organization
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Legal Business Name | PHOENIX BRIDGE GROUP HOMES, INC.
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 3309 N NC HIGHWAY 49 # A
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City | BURLINGTON
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State | NC
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Zip | 27217-8589
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Country | US
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Telephone | 336-578-0540
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Fax | 336-222-8533
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Provider Business Mailing Address
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Address Line | 120 S MAIN ST
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City | GRAHAM
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State | NC
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Zip | 27253-2808
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Country | US
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Telephone | 336-222-8522
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Fax | 336-222-8533
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Authorized Official
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Title or Position | PROGRAM MANAGER
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Name | MISS WENDY RENEE JONES
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Credential |
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Telephone | 336-222-8522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | MHL 001-120
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | MHL 001-100
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | MHL 001-121
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | MHL -001 - 135
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License Number State | NC
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Taxonomy #5
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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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