Provider Demographics
NPI:1700665353
Name:PHENIX MENTAL WEALTH
Entity Type:Organization
Organization Name:PHENIX MENTAL WEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHENIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-624-9421
Mailing Address - Street 1:941 SOUTH AVE APT B5
Mailing Address - Street 2:
Mailing Address - City:SECANE
Mailing Address - State:PA
Mailing Address - Zip Code:19018-3419
Mailing Address - Country:US
Mailing Address - Phone:267-624-9421
Mailing Address - Fax:
Practice Address - Street 1:2401 WALNUT ST STE 102
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-4341
Practice Address - Country:US
Practice Address - Phone:267-624-9421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:B UNLIMITED CREATIVE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care