Organization
PHOENIX BRIDGE COMMUNITY SUPPORT
Active
Parent organization
PHOENIX BRIDGE GROUP HOME, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
PHOENIX BRIDGE GROUP HOME, INC.
Authorized official
MISS WENDY RENEE JONES (PROGRAM DIRECTOR)
(336) 222-8522
Entity
Organization
Contact information
Practice address
814 BRADLEY ST, BURLINGTON, NC 27215-6806
(336) 222-8522
(336) 222-8533
Mailing address
909 A SOUTH MAIN STREET, BURLINGTON, NC 27215-5756
(336) 222-8522
(336) 222-8533
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL-001-121
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6603578
—
NC
Enumeration date
11/01/2007
Last updated
11/01/2007
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