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NPI Code Detail

MEDICARE: PHOENIX GROUP HOME, LLC

MEDICARE: PHOENIX GROUP HOME, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13245S0500XChildren's Substance Abuse Rehabilitation Facility
2251S00000XCommunity/Behavioral Health Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083146013
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHOENIX GROUP HOME, LLC
Provider Business Mailing Address
First Line : PO BOX 900926
Second Line :
City : SANDY
State : UT
Zip : 84090-0926
Country : US
Telephone Number : 740-858-1659
Fax Number : 513-221-2093
Provider Business Practice Location Address
First Line : 902 GALLIA ST
Second Line :
City : PORTSMOUTH
State : OH
Zip : 45662-4139
Country : US
Telephone Number : 740-529-2125
Fax Number : 740-529-2126
Authorized Official
Title or Position : OWNER
Name : MR. MARSHAL LUNT
Credential :
Telephone Number : 801-560-3822
Provider Enumeration Date : 03/29/2017
Last Update Date : 02/09/2026

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Directions to “PHOENIX GROUP HOME, LLC ” Practice Location

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