Organization
PHOENIX LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOQUANA GOYNES (EXECUTIVE DIRECTOR)
(402) 378-5755
Entity
Organization
Contact information
Practice address
2226 5TH AVE, COUNCIL BLUFFS, IA 51501-3735
(402) 378-5755
Mailing address
2226 5TH AVE, COUNCIL BLUFFS, IA 51501-3735
(402) 378-5755
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
12/28/2020
Last updated
09/11/2024
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