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General NPI Number Information
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NPI Number | 1912354572
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Entity Type | Organization
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Legal Business Name | PHOENIX PROGRAMS, INC.
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Dates
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Enumeration Date | 05/24/2016
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Last Update Date | 05/24/2016
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Provider Practice Location Address
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Address Line | 90 E LESLIE LN
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City | COLUMBIA
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State | MO
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Zip | 65202-1535
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Country | US
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Telephone | 573-875-8880
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Fax | 573-442-3830
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Provider Business Mailing Address
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Address Line | 90 E LESLIE LANE
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City | COLUMBIA
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State | MO
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Zip | 65202
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Country | US
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Telephone | 573-875-8880
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Fax | 573-442-3830
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Authorized Official
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Title or Position | VETERANS SPECIALIST
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Name | MRS. LAURA L CAMERON
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Credential | RASAC II
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Telephone | 573-875-8880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State | MO
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