Provider Demographics
NPI:1891495719
Name:THE PHOENIX GROUP HOMES LLC
Entity Type:Organization
Organization Name:THE PHOENIX GROUP HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HYACINTH
Authorized Official - Middle Name:
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-748-0919
Mailing Address - Street 1:1150 ALSTEAD CT NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-8653
Mailing Address - Country:US
Mailing Address - Phone:602-748-0919
Mailing Address - Fax:
Practice Address - Street 1:1150 ALSTEAD CT NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-8653
Practice Address - Country:US
Practice Address - Phone:602-748-0919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE PHOENIX GROUP HOMES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness