# PHOENIX CM INCORPORATED

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

## Provider details

- **NPI number:** 1306103353
- **Authorized official:** MS. ELLA B. RUSSELL (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (443) 880-6124

## Contact information

- **Practice address:** 52 TUSCAN WAY, STE. 202-142, SAINT AUGUSTINE, FL 32092-1850
- **Practice address phone:** (904) 201-9275
- **Mailing address:** 52 TUSCAN WAY, STE. 202-142, SAINT AUGUSTINE, FL 32092-1850
- **Mailing address phone:** (904) 201-9275

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171M00000X | Case Manager/Care Coordinator | — | — | Yes |

## Other

- **Enumeration date:** 04/16/2012
- **Last updated:** 04/16/2012