Organization
PHOENIX ADOLESCENT OUTPATIENT TREATMENT
Active
Parent organization
PHOENIX GROUP HOMES, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
PHOENIX GROUP HOMES, INC.
Authorized official
MR. HOWARD LOUIS MEIER JR. LADC (EXECUTIVE DIRECTOR)
(651) 230-1895
Entity
Organization
Contact information
Practice address
2055 WHITE BEAR AVE N, MAPLEWOOD, MN 55109-3716
(651) 734-3268
(612) 378-4886
Mailing address
1011 INTERLACHEN PKWY, WOODBURY, MN 55125-8852
(651) 230-0849
(651) 773-5894
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1048347-1-CDT
MN
Other
Enumeration date
02/27/2008
Last updated
02/27/2008
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