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General NPI Number Information
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NPI Number | 1932591187
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Entity Type | Organization
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Legal Business Name | PHOENIX RECOVERY CENTER, LLC
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Dates
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Enumeration Date | 02/25/2015
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Last Update Date | 02/25/2015
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Provider Practice Location Address
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Address Line | 1224 JERSEY ST
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City | CONWAY
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State | AR
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Zip | 72032-4658
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Country | US
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Telephone | 501-499-6696
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Fax | 501-499-6639
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Provider Business Mailing Address
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Address Line | 1224 JERSEY ST
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City | CONWAY
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State | AR
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Zip | 72032-4658
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Country | US
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Telephone | 501-499-6696
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Fax | 501-499-6639
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. MATTHEW FERGUSON BELL
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Credential |
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Telephone | 501-539-1501
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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 | AR
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