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General NPI Number Information
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NPI Number | 1972059806
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Entity Type | Organization
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Legal Business Name | PHOENIX HEALING CENTER LLC
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Dates
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Enumeration Date | 08/31/2016
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Last Update Date | 08/31/2016
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Provider Practice Location Address
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Address Line | 1812 2ND ST SW SUITE F
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City | ROCHESTER
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State | MN
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Zip | 55902-4127
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Country | US
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Telephone | 507-322-0222
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Fax | 507-322-0223
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Provider Business Mailing Address
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Address Line | 1812 2ND ST SW SUITE F
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City | ROCHESTER
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State | MN
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Zip | 55902-4127
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Country | US
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Telephone | 507-322-0222
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Fax | 507-322-0223
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Authorized Official
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Title or Position | PMH-CNS, APRN-BC
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Name | KATHLEEN FRANCETTE FLUGEL COLLE
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Credential |
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Telephone | 507-421-2737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | R 121129-6
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License Number State | MN
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