Provider Demographics
NPI:1437213634
Name:PHOENIX PROGRAMS, INC.
Entity Type:Organization
Organization Name:PHOENIX PROGRAMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BESTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-875-8880
Mailing Address - Street 1:90 E LESLIE LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-1535
Mailing Address - Country:US
Mailing Address - Phone:573-875-8880
Mailing Address - Fax:
Practice Address - Street 1:90 E LESLIE LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-1535
Practice Address - Country:US
Practice Address - Phone:573-875-8880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility