Provider Demographics
NPI:1841379310
Name:PHOENIX CENTER COMMUNITY SERVICE BOARD
Entity Type:Organization
Organization Name:PHOENIX CENTER COMMUNITY SERVICE BOARD
Other - Org Name:PHOENIX CENTER BHS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-988-1002
Mailing Address - Street 1:940 GA HIGHWAY 96
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-2584
Mailing Address - Country:US
Mailing Address - Phone:478-988-1002
Mailing Address - Fax:
Practice Address - Street 1:100 STORY RD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-1247
Practice Address - Country:US
Practice Address - Phone:478-988-1002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health