Provider Demographics
NPI:1962658377
Name:PHOENIX-RESTORATION FACILITIES, INC.
Entity Type:Organization
Organization Name:PHOENIX-RESTORATION FACILITIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:C
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:LINCOLN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-377-6640
Mailing Address - Street 1:5118 STAGE RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-3166
Mailing Address - Country:US
Mailing Address - Phone:901-377-6640
Mailing Address - Fax:901-377-2450
Practice Address - Street 1:5118 STAGE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-3166
Practice Address - Country:US
Practice Address - Phone:901-377-6640
Practice Address - Fax:901-377-2450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty