Provider Demographics
NPI:1104188580
Name:PHOENIX REHABILITATION AND HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:PHOENIX REHABILITATION AND HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:METAL-CONFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-448-2733
Mailing Address - Street 1:PO BOX 392573
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-9573
Mailing Address - Country:US
Mailing Address - Phone:724-584-5739
Mailing Address - Fax:724-343-4069
Practice Address - Street 1:2000 WESTINGHOUSE DR STE 200
Practice Address - Street 2:
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-5238
Practice Address - Country:US
Practice Address - Phone:724-584-5739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101954133001Medicaid
PA101954133001Medicaid