Provider Demographics
NPI:1437384518
Name:PHOENIXCO.
Entity Type:Organization
Organization Name:PHOENIXCO.
Other - Org Name:TOWNSEND RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:POLLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-315-9456
Mailing Address - Street 1:36132 EMERALD COAST PKWY
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-5776
Mailing Address - Country:US
Mailing Address - Phone:850-424-3914
Mailing Address - Fax:850-424-3931
Practice Address - Street 1:348 MIRACLE STRIP PKWY SW STE 13
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5258
Practice Address - Country:US
Practice Address - Phone:850-244-2900
Practice Address - Fax:850-796-2700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder