Organization
PHOENIX CM INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ELLA B. RUSSELL (EXECUTIVE DIRECTOR)
(443) 880-6124
Entity
Organization
Contact information
Practice address
52 TUSCAN WAY, STE. 202-142, SAINT AUGUSTINE, FL 32092-1850
(904) 201-9275
Mailing address
52 TUSCAN WAY, STE. 202-142, SAINT AUGUSTINE, FL 32092-1850
(904) 201-9275
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
04/16/2012
Last updated
04/16/2012
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