Provider Demographics
NPI:1598477457
Name:PHOENIX RESIDENTIAL INVESTMENT GROUP
Entity Type:Organization
Organization Name:PHOENIX RESIDENTIAL INVESTMENT GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DETITRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUTIZWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-301-8900
Mailing Address - Street 1:608 CHAPEL PL
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-1760
Mailing Address - Country:US
Mailing Address - Phone:214-301-8900
Mailing Address - Fax:
Practice Address - Street 1:127 WILSON RD
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-9185
Practice Address - Country:US
Practice Address - Phone:214-301-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253J00000XAgenciesFoster Care Agency
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty