Organization
THE PHOENIX GROUP, LLC
Active
Other names
The Phoenix Group
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEITH DUANE MCMILLEN (OPERATIONS DIRECTOR)
(712) 355-8665
Entity
Organization
Contact information
Practice address
200 S 37TH ST APT F, COUNCIL BLUFFS, IA 51501-3284
(712) 355-8665
Mailing address
200 S 37TH ST APT F, COUNCIL BLUFFS, IA 51501-3284
(712) 355-8665
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
489DLC-456043
IA
Other
Enumeration date
05/01/2013
Last updated
07/09/2014
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