Provider Demographics
NPI:1164729653
Name:THE PHOENIX FAMILY NETWORK
Entity Type:Organization
Organization Name:THE PHOENIX FAMILY NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:HAZIM
Authorized Official - Middle Name:TAALIB
Authorized Official - Last Name:MAJEED
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:704-219-1374
Mailing Address - Street 1:1201 MAIN ST
Mailing Address - Street 2:1980
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-3200
Mailing Address - Country:US
Mailing Address - Phone:704-219-1374
Mailing Address - Fax:803-748-1288
Practice Address - Street 1:1201 MAIN ST
Practice Address - Street 2:1980
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3200
Practice Address - Country:US
Practice Address - Phone:704-219-1374
Practice Address - Fax:803-748-1288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health