Organization
PHOENIX OUTDOOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KAREN NILSEN (OFFICE ASSISTANT)
(828) 668-7590
Entity
Organization
Contact information
Practice address
631 WILLOW CREEK RD, LEICESTER, NC 28748-5646
(828) 683-7718
(828) 683-9995
Mailing address
631 WILLOW CREEK RD, LEICESTER, NC 28748-5646
(828) 683-7718
(828) 683-9995
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
MHL-011-279
NC
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
MHL-011-279
NC
Other
Enumeration date
03/16/2009
Last updated
03/16/2009
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