Provider Demographics
NPI:1336410349
Name:PHOENIX RISING NOW CORPORATION
Entity Type:Organization
Organization Name:PHOENIX RISING NOW CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:407-267-0415
Mailing Address - Street 1:2625 TWEED RUN
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-6499
Mailing Address - Country:US
Mailing Address - Phone:407-267-0415
Mailing Address - Fax:
Practice Address - Street 1:1540 INTERNATIONAL PKWY
Practice Address - Street 2:SUITE 2000
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-4713
Practice Address - Country:US
Practice Address - Phone:407-267-0415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-23
Last Update Date:2012-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2629251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health