Provider Demographics
NPI:1740402155
Name:PHOENIX COMMUNITY SERVICES
Entity Type:Organization
Organization Name:PHOENIX COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN,
Authorized Official - Phone:765-622-7808
Mailing Address - Street 1:1200 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-5631
Mailing Address - Country:US
Mailing Address - Phone:765-622-7808
Mailing Address - Fax:765-622-7858
Practice Address - Street 1:1200 E 32ND ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-5631
Practice Address - Country:US
Practice Address - Phone:765-622-7808
Practice Address - Fax:765-622-7858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services