Organization
THE PHOENIX HOUSE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISTY DAWN PANTHER (EXECUTIVE DIRECTOR)
(918) 896-8380
Entity
Organization
Contact information
Practice address
106 CHASTEEN DR, MIDDLESBORO, KY 40965-2519
(918) 896-8380
Mailing address
106 CHASTEEN DR, MIDDLESBORO, KY 40965-2519
(918) 896-8380
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
04/20/2026
Last updated
04/20/2026
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