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General NPI Number Information
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NPI Number | 1679997266
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Entity Type | Organization
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Legal Business Name | PHOENIX BEHAVIORAL SERVICES, INC
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Dates
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Enumeration Date | 02/18/2014
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Last Update Date | 02/18/2014
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Provider Practice Location Address
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Address Line | 4649 147TH STREET
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City | MIDLOTHIAN
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State | IL
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Zip | 60445
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Country | US
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Telephone | 708-926-2789
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Fax | 708-926-2797
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Provider Business Mailing Address
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Address Line | 4649 147TH STREET
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City | MIDLOTHIAN
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State | IL
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Zip | 60445
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Country | US
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Telephone | 708-926-2789
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Fax | 708-926-2797
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | JAMES GOLDING
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Credential | MSW, MHS, CAADC, MAC
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Telephone | 708-926-2789
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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 | A58510002A
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License Number State | IL
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