Organization
PHOENIX RISEN, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHIQUITA CONNER CSA (OWNER)
(804) 651-2688
Entity
Organization
Contact information
Practice address
2112 RATCLIFFE AVE, LOUISVILLE, KY 40210-2252
(804) 651-2688
Mailing address
6709 REBECCA LN, LOUISVILLE, KY 40258-3011
(804) 651-2688
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
09/09/2024
Last updated
09/09/2024
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