Provider Demographics
NPI:1750509014
Name:THE PHOENIX HOUSE OF SANTA BARBARA
Entity Type:Organization
Organization Name:THE PHOENIX HOUSE OF SANTA BARBARA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QMHW
Authorized Official - Prefix:MR
Authorized Official - First Name:MESUT
Authorized Official - Middle Name:
Authorized Official - Last Name:INCI
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MFT INTERN
Authorized Official - Phone:805-636-3135
Mailing Address - Street 1:7170 DAVENPORT RD
Mailing Address - Street 2:108
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-2955
Mailing Address - Country:US
Mailing Address - Phone:805-636-3135
Mailing Address - Fax:
Practice Address - Street 1:7170 DAVENPORT RD
Practice Address - Street 2:108
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117-2955
Practice Address - Country:US
Practice Address - Phone:805-636-3135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320800000X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Not Answered324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility