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NPI Code Detail

MEDICARE: PHOENIX HOUSE, INC.

MEDICARE: PHOENIX HOUSE, INC.
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
1322D00000XEmotionally Disturbed Childrens' Residential Treatment FacilityNC

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 : 1124164405
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHOENIX HOUSE, INC.
Provider Business Mailing Address
First Line : 8916 WOODHALL LAKE DR
Second Line :
City : WAXHAW
State : NC
Zip : 28173-6800
Country : US
Telephone Number : 704-536-7931
Fax Number :
Provider Business Practice Location Address
First Line : 8916 WOODHALL LAKE DR
Second Line :
City : WAXHAW
State : NC
Zip : 28173-6800
Country : US
Telephone Number : 704-536-7931
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : LESLIE TAYLOR
Credential :
Telephone Number : 704-536-7931
Provider Enumeration Date : 01/30/2007
Last Update Date : 08/22/2020

Similar Medicare Providers

1942394101 — PHOENIX HOUSE, INC
Practice Location Address:
8916 WOODHALL LAKE DR
WAXHAW, NC
28173-6800
Practice Phone: 704-536-7931
Practice Fax:
1861529398 — PHOENIX HOUSE INC.
Practice Location Address:
8916 WOODHALL LAKE DR
WAXHAW, NC
28173-6800
Practice Phone: 704-536-7931
Practice Fax:
1053586065 — PHOENIX HOUSE CHILD AGENCY
Practice Location Address:
8916 WOODHALL LAKE DR
WAXHAW, NC
28173-6800
Practice Phone: 704-536-7931
Practice Fax:
1699196535 — RALPH TAYLOR
Practice Location Address:
8916 WOODHALL LAKE DR
WAXHAW, NC
28173-6800
Practice Phone: 704-968-0345
Practice Fax:
1710308648 — LESLIE TAYLOR
Practice Location Address:
8916 WOODHALL LAKE DR
WAXHAW, NC
28173-6800
Practice Phone: 704-968-0345
Practice Fax:
1447964382 — MORGAN FOSTER OTR/L
Practice Location Address:
2300 GALLBERRY LN
WAXHAW, NC
28173-0161
Practice Phone: 704-649-4509
Practice Fax: 704-843-9045

Directions to “PHOENIX HOUSE, INC. ” Practice Location

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