Organization
PHOENIX MANAGEMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MERINDA HALLADAY (OWNER/ADMINISTRATOR)
(208) 317-3625
Entity
Organization
Contact information
Practice address
10991 DEERRIDGE DR., CHUBBUCK, ID 83202
(208) 317-3625
Mailing address
10991 DEERRIDGE DR., CHUBBUCK, ID 83202
(208) 317-3625
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
ID
Other
Enumeration date
03/05/2015
Last updated
03/05/2015
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