Provider Demographics
NPI:1164021820
Name:PHOENIX RECOVERY HOUSE
Entity Type:Organization
Organization Name:PHOENIX RECOVERY HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GRAY
Authorized Official - Last Name:MCKEE
Authorized Official - Suffix:II
Authorized Official - Credentials:FOUNDER/THERAPIST
Authorized Official - Phone:610-350-9100
Mailing Address - Street 1:611 WEIR RD
Mailing Address - Street 2:
Mailing Address - City:ASTON
Mailing Address - State:PA
Mailing Address - Zip Code:19014-1634
Mailing Address - Country:US
Mailing Address - Phone:610-350-9100
Mailing Address - Fax:302-655-5317
Practice Address - Street 1:109 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-2729
Practice Address - Country:US
Practice Address - Phone:610-350-9100
Practice Address - Fax:302-655-5317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility