Provider Demographics
NPI:1063044394
Name:PHOENIX CENTER, INC.
Entity Type:Organization
Organization Name:PHOENIX CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PROGRAM OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:LICDC
Authorized Official - Phone:207-602-8683
Mailing Address - Street 1:21 N SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-2211
Mailing Address - Country:US
Mailing Address - Phone:937-481-5431
Mailing Address - Fax:
Practice Address - Street 1:1007 N 2ND ST
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-1235
Practice Address - Country:US
Practice Address - Phone:740-442-7045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-05
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty