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NPI Code Detail

MEDICARE: THE PHOENIX RECOVERY SUPPORT SERVICES AND SOBER LIVING ENVIRONMENTS LL

MEDICARE: THE PHOENIX RECOVERY SUPPORT SERVICES AND SOBER LIVING ENVIRONMENTS LL
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
1175T00000XPeer Specialist

General Provider Information

NPI Number : 1225769847
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE PHOENIX RECOVERY SUPPORT SERVICES AND SOBER LIVING ENVIRONMENTS LL
Provider Business Mailing Address
First Line : 3311 12TH ST NW
Second Line :
City : CANTON
State : OH
Zip : 44708-3909
Country : US
Telephone Number : 234-214-9731
Fax Number :
Provider Business Practice Location Address
First Line : 3311 12TH ST NW
Second Line :
City : CANTON
State : OH
Zip : 44708-3909
Country : US
Telephone Number : 234-214-9731
Fax Number :
Authorized Official
Title or Position : CHIEF OPERATING OFFICER
Name : MR. KOREY ALAN MCCREERY
Credential : PRSS
Telephone Number : 234-214-9731
Provider Enumeration Date : 06/23/2022
Last Update Date : 02/07/2023

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Directions to “THE PHOENIX RECOVERY SUPPORT SERVICES AND SOBER LIVING ENVIRONMENTS LL ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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