Provider Demographics
NPI:1356196299
Name:THE PHOENIX RISING, LLC
Entity type:Organization
Organization Name:THE PHOENIX RISING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTOYA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:505-261-8881
Mailing Address - Street 1:1617 INDIANA ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-6915
Mailing Address - Country:US
Mailing Address - Phone:505-261-8881
Mailing Address - Fax:
Practice Address - Street 1:9301 INDIAN SCHOOL RD NE STE 101-E
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2884
Practice Address - Country:US
Practice Address - Phone:505-261-8881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-23
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty