| NPI | 1689119836 |
|---|---|
| Other Name | PHOENIX HOME |
| Entity Type | Organization |
| Authorized Contact | MARY A PANK Paralegal 502-420-2666 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2016-12-27 |
| Last Update Date | 2016-12-27 |