# PHOENIX TREATMENT CENTER INC

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

## Provider details

- **NPI number:** 1699440263
- **Authorized official:** MOHAMMAD KALOU MD (OWNER)
- **Authorized official phone:** (304) 688-7027

## Contact information

- **Practice address:** 4114 1ST AVE, NITRO, WV 25143-1304
- **Practice address phone:** (304) 755-0119
- **Mailing address:** PO BOX 11908, CHARLESTON, WV 25339-1908

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0000X | Adolescent Medicine (Family Medicine) Physician | — | NULL | Yes |
| 207QA0000X | Adolescent Medicine (Family Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/15/2021
- **Last updated:** 08/15/2021