Provider Demographics
NPI:1790533800
Name:PHOENIX RISING TREATMENT, LLC.
Entity type:Organization
Organization Name:PHOENIX RISING TREATMENT, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLAINCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DANE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:CADC-II, CCS
Authorized Official - Phone:714-561-8063
Mailing Address - Street 1:392 E 3900 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-1615
Mailing Address - Country:US
Mailing Address - Phone:801-856-7799
Mailing Address - Fax:
Practice Address - Street 1:392 E 3900 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-1615
Practice Address - Country:US
Practice Address - Phone:801-856-7799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health