Provider Demographics
NPI:1265502025
Name:MIDDLE FLINT AREA COMMUNITY SERVICE BOARD
Entity Type:Organization
Organization Name:MIDDLE FLINT AREA COMMUNITY SERVICE BOARD
Other - Org Name:PHOENIX CENTER BHS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RCM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-815-5454
Mailing Address - Street 1:940 GA HIGHWAY 96 STE C
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-2585
Mailing Address - Country:US
Mailing Address - Phone:478-988-7100
Mailing Address - Fax:478-988-7115
Practice Address - Street 1:940 GA HIGHWAY 96 STE C
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-2585
Practice Address - Country:US
Practice Address - Phone:478-988-1002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA582105225251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000918068AMedicaid
GA000918068BMedicaid
GAGRP1953OtherMEDICARE GROUP NUMBER