Provider Demographics
NPI:1568850485
Name:PHOENIX OF HEALTH, LLC
Entity Type:Organization
Organization Name:PHOENIX OF HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOY
Authorized Official - Middle Name:RAMSAY
Authorized Official - Last Name:FARAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-420-0000
Mailing Address - Street 1:221 E ANTIETAM ST
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5724
Mailing Address - Country:US
Mailing Address - Phone:240-420-0000
Mailing Address - Fax:240-420-0002
Practice Address - Street 1:221 E ANTIETAM ST
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5724
Practice Address - Country:US
Practice Address - Phone:240-420-0000
Practice Address - Fax:240-420-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0016982261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty