Provider Demographics
NPI:1245588946
Name:PHOENIX REHABILITATION AND HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:PHOENIX REHABILITATION AND HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:REDFERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-343-4060
Mailing Address - Street 1:PO BOX 392573
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-8096
Mailing Address - Country:US
Mailing Address - Phone:724-343-4060
Mailing Address - Fax:724-343-4068
Practice Address - Street 1:1700 OLD GATESBURG ROAD
Practice Address - Street 2:SUITE 210
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803
Practice Address - Country:US
Practice Address - Phone:814-278-1912
Practice Address - Fax:814-278-1921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005902L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
02679500OtherCAPITAL BLUE CROSS
PA1019541330001Medicaid
PA=========OtherTRICARE
02679500OtherCAPITAL BLUE CROSS
=========OtherHEALTH AMERICA HEALTH ASSURANCE
PA=========OtherAETNA