Provider Demographics
NPI:1225454945
Name:THE PHOENIX OF SANTA BARBARA
Entity Type:Organization
Organization Name:THE PHOENIX OF SANTA BARBARA
Other - Org Name:CRESCEND HEALTH - DUAL DIAGNOSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:805-965-3434
Mailing Address - Street 1:107 E MICHELTORENA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-1905
Mailing Address - Country:US
Mailing Address - Phone:805-965-3434
Mailing Address - Fax:805-965-3797
Practice Address - Street 1:110 LA PAZ
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101
Practice Address - Country:US
Practice Address - Phone:805-965-3434
Practice Address - Fax:805-965-3797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-06
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA424275000Medicaid