Provider Demographics
NPI:1235994138
Name:PHOENIX PEER SERVICES LLC
Entity Type:Organization
Organization Name:PHOENIX PEER SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:CPS
Authorized Official - Phone:570-485-8212
Mailing Address - Street 1:PO BOX 512
Mailing Address - Street 2:
Mailing Address - City:WYSOX
Mailing Address - State:PA
Mailing Address - Zip Code:18854-0512
Mailing Address - Country:US
Mailing Address - Phone:570-485-8212
Mailing Address - Fax:
Practice Address - Street 1:7406 ROUTE 487 STE 1
Practice Address - Street 2:
Practice Address - City:MILDRED
Practice Address - State:PA
Practice Address - Zip Code:18632-9031
Practice Address - Country:US
Practice Address - Phone:570-485-8212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty