Provider Demographics
NPI:1114484961
Name:PHOENIX INTEGRATED HEALTH LLC
Entity Type:Organization
Organization Name:PHOENIX INTEGRATED HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BURT
Authorized Official - Middle Name:
Authorized Official - Last Name:DHIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-389-3030
Mailing Address - Street 1:5945 SAWMILL RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-1623
Mailing Address - Country:US
Mailing Address - Phone:614-389-3030
Mailing Address - Fax:
Practice Address - Street 1:5945 SAWMILL RD UNIT B
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1623
Practice Address - Country:US
Practice Address - Phone:614-389-3030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHOENIX INTEGRATED HEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-28
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health