Organization
PHOENIX PARAMEDIC SOLUTIONS; LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NATHANIEL A METZ (CEO)
(765) 448-4327
Entity
Organization
Contact information
Practice address
3554 PROMENADE PKWY STE B, LAFAYETTE, IN 47909-8418
(765) 637-7161
Mailing address
3554 PROMENADE PKWY STE B, LAFAYETTE, IN 47909-8418
(765) 637-7161
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2131-0-ASO
ADDICTIONS SERVICES PROVIDER-OUTPATIENT
IN
Enumeration date
03/18/2024
Last updated
03/18/2024
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