Provider Demographics
NPI:1841403136
Name:PHOENIX HOUSE
Entity Type:Organization
Organization Name:PHOENIX HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRUINS
Authorized Official - Suffix:
Authorized Official - Credentials:RCS, LCDP
Authorized Official - Phone:401-348-9995
Mailing Address - Street 1:101 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-3198
Mailing Address - Country:US
Mailing Address - Phone:401-348-9995
Mailing Address - Fax:401-348-2004
Practice Address - Street 1:101 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-3198
Practice Address - Country:US
Practice Address - Phone:401-348-9995
Practice Address - Fax:401-348-9995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder