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General NPI Number Information
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NPI Number | 1740990084
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Entity Type | Organization
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Legal Business Name | PHOENIX DEVELOPMENTAL SERVICES LLC
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Dates
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Enumeration Date | 11/28/2022
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Last Update Date | 11/28/2022
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Provider Practice Location Address
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Address Line | 1114 EAST ST APT 2
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City | EMPORIA
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State | KS
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Zip | 66801-7103
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Country | US
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Telephone | 620-481-7728
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 W VIEW TER
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City | EMPORIA
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State | KS
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Zip | 66801-5951
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Country | US
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Telephone | 620-481-7728
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Fax |
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Authorized Official
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Title or Position | OWNER-DIRECTOR
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Name | MR. ROY T LINGENFELTER
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Credential |
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Telephone | 620-481-7728
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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