# PHOENIX HOMES \#2

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

## Provider details

- **NPI number:** 1679707574
- **Authorized official:** MR. LOTANNA OMEZE NWANKWO (DIRECTOR/ADMINISTRATOR)
- **Authorized official phone:** (919) 522-9896

## Contact information

- **Practice address:** 5628 MILLRACE TRL, RALEIGH, NC 27606-9227
- **Practice address phone:** (919) 522-9896
- **Practice address fax:** (919) 231-1456
- **Mailing address:** 5628 MILLRACE TRL, RALEIGH, NC 27606-9227
- **Mailing address phone:** (919) 522-9896
- **Mailing address fax:** (919) 231-1456

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | MHL-092-741 | NC | Yes |

## Other

- **Enumeration date:** 05/06/2009
- **Last updated:** 05/06/2009