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Organization
PHOENIX HOUSE, INC.
Active
Organization
PHOENIX HOUSE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESLIE TAYLOR (DIRECTOR)
(704) 536-7931
Entity
Organization
Contact information
Practice address
8916 WOODHALL LAKE DR, WAXHAW, NC 28173-6800
(704) 536-7931
Mailing address
8916 WOODHALL LAKE DR, WAXHAW, NC 28173-6800
(704) 536-7931
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6603730
—
NC
Enumeration date
01/30/2007
Last updated
08/22/2020
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