Organization
PHOENIX RESIDENTIAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL ROBINSON (CEO)
(567) 868-7810
Entity
Organization
Contact information
Practice address
2200 W ALEXIS RD STE B, TOLEDO, OH 43613-2100
(567) 868-7810
Mailing address
PO BOX 146, HOLLAND, OH 43528-0146
(567) 868-7810
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
07/10/2024
Last updated
07/10/2024
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