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General NPI Number Information
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NPI Number | 1740687664
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Entity Type | Organization
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Legal Business Name | PHOENIX CM INC.
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Dates
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Enumeration Date | 11/20/2014
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Last Update Date | 11/20/2014
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Provider Practice Location Address
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Address Line | 1225 W BEAVER ST STE 101
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City | JACKSONVILLE
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State | FL
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Zip | 32204-1415
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Country | US
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Telephone | 904-377-6735
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Fax |
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Provider Business Mailing Address
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Address Line | 52 TUSCAN WAY STE 202-142 STE. 202-142
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32092-1850
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Country | US
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Telephone | 904-377-6735
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ELLA B RUSSELL
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Credential |
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Telephone | 904-377-6735
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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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