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General NPI Number Information
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NPI Number | 1902350127
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Entity Type | Organization
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Legal Business Name | PHOENIX RESOURCES INC
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Dates
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Enumeration Date | 08/04/2016
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Last Update Date | 08/04/2016
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Provider Practice Location Address
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Address Line | 585 N 25TH ST
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-7956
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Country | US
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Telephone | 970-424-3662
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Fax |
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Provider Business Mailing Address
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Address Line | 585 N 25TH ST
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-7956
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Country | US
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Telephone | 970-424-3662
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KRISTIN M WARD
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Credential |
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Telephone | 970-424-3662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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