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Organization

PHOENIX CLINIC, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
BONNIE GRAHAM (CHIEF EXECUTIVE OFFICER)
(305) 891-3439
Entity
Organization

Contact information

Practice address
13730 NW 6TH CT, NORTH MIAMI, FL 33168-2931
(305) 891-3439
Mailing address
13730 NW 6TH CT, NORTH MIAMI, FL 33168-2931
(305) 891-3439

Taxonomy

Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
1113AD081801
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1113AD081801
SUBSTANCE ABUSE LICENSE
FL
Enumeration date
10/03/2006
Last updated
08/27/2008
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