Provider Demographics
NPI:1639958473
Name:PHOENIX SOLUTIONS FOR HEALTH LLC
Entity Type:Organization
Organization Name:PHOENIX SOLUTIONS FOR HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTONGUAY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:833-707-4636
Mailing Address - Street 1:2 SHEARWATER ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03824-3335
Mailing Address - Country:US
Mailing Address - Phone:833-707-4636
Mailing Address - Fax:845-625-1403
Practice Address - Street 1:95 BREWERY LN STE 51
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4994
Practice Address - Country:US
Practice Address - Phone:833-707-4636
Practice Address - Fax:845-625-1403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3095887Medicaid