Provider Demographics
NPI:1740990084
Name:PHOENIX DEVELOPMENTAL SERVICES LLC
Entity type:Organization
Organization Name:PHOENIX DEVELOPMENTAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:T
Authorized Official - Last Name:LINGENFELTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-481-7728
Mailing Address - Street 1:2400 W VIEW TER
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-5951
Mailing Address - Country:US
Mailing Address - Phone:620-481-7728
Mailing Address - Fax:
Practice Address - Street 1:1114 EAST ST APT 2
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-7103
Practice Address - Country:US
Practice Address - Phone:620-481-7728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services