Organization
PHOENIX BRIDGE GROUP HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WENDY JONES (PROGRAM DIRECTOR)
(336) 222-8522
Entity
Organization
Contact information
Practice address
909 A SOUTH MAIN STREET, BURLINGTON, NC 27215-0169
(336) 222-8522
Mailing address
909 A SOUTH MAIN STREET, BURLINGTON, NC 27215-0169
(336) 222-8522
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8302247
—
NC
Enumeration date
05/29/2008
Last updated
05/29/2008
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