Provider Demographics
NPI:1295107241
Name:THE PHOENIX RECOVERY CENTER - FEMALE HOUSE
Entity type:Organization
Organization Name:THE PHOENIX RECOVERY CENTER - FEMALE HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-773-5857
Mailing Address - Street 1:11762 S STATE ST
Mailing Address - Street 2:SUITE 360
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-7155
Mailing Address - Country:US
Mailing Address - Phone:801-571-6798
Mailing Address - Fax:801-619-2016
Practice Address - Street 1:9538 S MORYWOOD LN
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-2349
Practice Address - Country:US
Practice Address - Phone:801-571-6798
Practice Address - Fax:801-619-2016
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE PHOENIX RECOVERY CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility