Provider Demographics
NPI:1093116071
Name:PHOENIX HOUSE - TAPESTRY
Entity Type:Organization
Organization Name:PHOENIX HOUSE - TAPESTRY
Other - Org Name:PHOENIX HOUSES OF NEW ENGLAN, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT/VERMONT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-345-3593
Mailing Address - Street 1:99 WAYLAND AVE
Mailing Address - Street 2:100
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4314
Mailing Address - Country:US
Mailing Address - Phone:401-331-4250
Mailing Address - Fax:401-421-5520
Practice Address - Street 1:178 LINDEN ST
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-2855
Practice Address - Country:US
Practice Address - Phone:802-257-2415
Practice Address - Fax:802-257-4617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000506320800000X
VT0680000733320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness