Provider Demographics
NPI:1083470462
Name:PHOENIX SOBRIETY
Entity Type:Organization
Organization Name:PHOENIX SOBRIETY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION/OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SACHEL
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-378-6789
Mailing Address - Street 1:1711 LIBERTY BELL WAY APT 3
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-1671
Mailing Address - Country:US
Mailing Address - Phone:502-593-6380
Mailing Address - Fax:
Practice Address - Street 1:1711 LIBERTY BELL WAY APT 3
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1671
Practice Address - Country:US
Practice Address - Phone:502-593-6380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-23
Last Update Date:2024-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder