Provider Demographics
NPI:1356441141
Name:PHOENIX HOUSES OF NE
Entity Type:Organization
Organization Name:PHOENIX HOUSES OF NE
Other - Org Name:PHOENIX HOUSE DUBLIN CTR
Other - Org Type:Other Name
Authorized Official - Title/Position:EXETUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MCENEANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-331-4250
Mailing Address - Street 1:131 WAYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4303
Mailing Address - Country:US
Mailing Address - Phone:401-331-4250
Mailing Address - Fax:401-331-5520
Practice Address - Street 1:1 PIERCE RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:NH
Practice Address - Zip Code:03444-0319
Practice Address - Country:US
Practice Address - Phone:603-563-8501
Practice Address - Fax:603-563-8296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH02724324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009358Medicaid
VT80092OtherBCBS