# PHOENIX CM INC.

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

## Provider details

- **NPI number:** 1740687664
- **Authorized official:** ELLA B RUSSELL (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (904) 377-6735

## Contact information

- **Practice address:** 1225 W BEAVER ST STE 101, JACKSONVILLE, FL 32204-1415
- **Practice address phone:** (904) 377-6735
- **Mailing address:** 52 TUSCAN WAY STE 202-142, STE. 202-142, SAINT AUGUSTINE, FL 32092-1850
- **Mailing address phone:** (904) 377-6735

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251B00000X | Case Management Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 11/20/2014
- **Last updated:** 11/20/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 006238200 | — | FL |