Provider Demographics
NPI:1528561933
Name:PHOENIX BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:PHOENIX BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:FUHRER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-771-3777
Mailing Address - Street 1:1014 WHITEHEAD ROAD EXT
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-2406
Mailing Address - Country:US
Mailing Address - Phone:609-771-3777
Mailing Address - Fax:
Practice Address - Street 1:1014 WHITEHEAD ROAD EXT
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08638-2406
Practice Address - Country:US
Practice Address - Phone:609-771-3777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-12
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0532550Medicaid