# PHOENIX RESIDENTIAL LLC

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

## Provider details

- **NPI number:** 1629815493
- **Authorized official:** MICHAEL ROBINSON (CEO)
- **Authorized official phone:** (567) 868-7810

## Contact information

- **Practice address:** 2200 W ALEXIS RD STE B, TOLEDO, OH 43613-2100
- **Practice address phone:** (567) 868-7810
- **Mailing address:** PO BOX 146, HOLLAND, OH 43528-0146
- **Mailing address phone:** (567) 868-7810

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 07/10/2024
- **Last updated:** 07/10/2024