# PHOENIX HOUSE, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124164405
- **Authorized official:** LESLIE TAYLOR (DIRECTOR)
- **Authorized official phone:** (704) 536-7931

## Contact information

- **Practice address:** 8916 WOODHALL LAKE DR, WAXHAW, NC 28173-6800
- **Practice address phone:** (704) 536-7931
- **Mailing address:** 8916 WOODHALL LAKE DR, WAXHAW, NC 28173-6800
- **Mailing address phone:** (704) 536-7931

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | — | NC | Yes |

## Other

- **Enumeration date:** 01/30/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 6603730 | — | NC |