Provider Demographics
NPI:1952045999
Name:PHIA T XIONG & JEFF D SPENCER FOUNDATION
Entity Type:Organization
Organization Name:PHIA T XIONG & JEFF D SPENCER FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PHIA
Authorized Official - Middle Name:TONY
Authorized Official - Last Name:XIONG
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:651-260-8707
Mailing Address - Street 1:2365 MCKNIGHT RD N
Mailing Address - Street 2:
Mailing Address - City:NORTH SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2238
Mailing Address - Country:US
Mailing Address - Phone:651-760-3236
Mailing Address - Fax:651-222-6025
Practice Address - Street 1:2365 MCKNIGHT RD N
Practice Address - Street 2:
Practice Address - City:NORTH SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55109-2238
Practice Address - Country:US
Practice Address - Phone:651-760-3236
Practice Address - Fax:651-222-6025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable