Organization
PHOENIX RISING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KWAME TANNER (OWNER)
(443) 315-6152
Entity
Organization
Contact information
Practice address
3106 E NORTHERN PKWY, BALTIMORE, MD 21214-1420
(410) 444-9999
(410) 444-9995
Mailing address
3106 E NORTHERN PKWY, BALTIMORE, MD 21214-1420
(410) 444-9999
(410) 444-9995
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
R2759
MD
Other
Enumeration date
09/02/2009
Last updated
09/02/2009
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