Provider Demographics
NPI:1982929592
Name:PHOENIX HOUSE
Entity Type:Organization
Organization Name:PHOENIX HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHOREY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:RAYMOND
Authorized Official - Suffix:
Authorized Official - Credentials:M ED
Authorized Official - Phone:413-739-2440
Mailing Address - Street 1:15 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01105-1433
Mailing Address - Country:US
Mailing Address - Phone:413-739-2440
Mailing Address - Fax:413-739-1087
Practice Address - Street 1:15 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-1433
Practice Address - Country:US
Practice Address - Phone:413-739-2440
Practice Address - Fax:413-739-1087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder