Organization
PHOENIX REHABILITATION SERVICES LLC
Active
Organization
PHOENIX REHABILITATION SERVICES LLC
Active
Other names
My Brothers Keepers
Organization subpart
No
Provider details
NPI number
Authorized official
TINTISHA CLANTON (CREDENTIALING/BILLING MANAGER)
(502) 229-7820
Entity
Organization
Contact information
Practice address
2184 S WILDERNESS RD, MOUNT VERNON, KY 40456-7631
(606) 256-0000
(606) 256-0008
Mailing address
2184 S WILDERNESS RD, MOUNT VERNON, KY 40456-7631
(606) 256-0000
(606) 256-0008
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
11/24/2025
Last updated
07/06/2026
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