MEDICARE: PHOENIX ALTERNATIVES, 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
1	251S00000X	Community/Behavioral Health Agency	2602	WI

Other Identifiers

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

General Provider Information

NPI Number	:	1275711772
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX ALTERNATIVES, LLC

Provider Business Mailing Address
First Line	:	1692 HIGHWAY 53 NORTH
Second Line	:
City	:	CHIPPEWA FALLS
State	:	WI
Zip	:	54729
Country	:	US
Telephone Number	:	715-830-8270
Fax Number	:	715-830-8272

Provider Business Practice Location Address
First Line	:	1692 HIGHWAY 53 NORTH
Second Line	:
City	:	CHIPPEWA FALLS
State	:	WI
Zip	:	54729
Country	:	US
Telephone Number	:	715-830-8270
Fax Number	:	715-830-8272

Authorized Official
Title or Position	:	CLINICAL MENTAL HEALTH DIRECTOR
Name	:	LOUISE GRUENWALD
Credential	:	M.S., LCSW
Telephone Number	:	715-830-8270

Provider Enumeration Date	:	02/06/2008
Last Update Date	:	02/06/2008

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Directions to “PHOENIX ALTERNATIVES, LLC ” Practice Location

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