Provider Demographics
NPI:1952570442
Name:PHOENIX SERVICES CORPORATION
Entity Type:Organization
Organization Name:PHOENIX SERVICES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NITA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-825-4535
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:189 S. STATE STREET SUITE 225
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84089-0457
Mailing Address - Country:US
Mailing Address - Phone:801-825-4535
Mailing Address - Fax:801-825-8281
Practice Address - Street 1:189 S STATE ST
Practice Address - Street 2:SUITE 225
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-1061
Practice Address - Country:US
Practice Address - Phone:801-825-4535
Practice Address - Fax:801-825-8281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2008-HHA-66098251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========011Medicaid
UT=========002Medicaid
UT=========002Medicaid