NPIMap

Organization Active NPI

Phoenix House

  • Substance Abuse Rehabilitation Facility
  • Springfield, MA
National Provider Identifier
1023408309
Registry record updated Jan 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
745 Issued in MA
Legal business name
PHOENIX HOUSE
Practice address
5 Madison Ave
Springfield, MA 01105-1403
Phone
(413) 733-6051
NPI assigned
Jan 26, 2015
Last updated
Jan 26, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ellen M Waltman, MED,LMHC
Title
Clinical Supervisor
Phone
(413) 355-6832

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Exclusive Provider Organization 302F00000X 745 MA
Substance Abuse Rehabilitation Facility 324500000X 745 MA Primary
Community/Behavioral Health Agency 251S00000X 745 MA

Addresses

Primary practice location

5 Madison Ave
Springfield, MA 01105-1403

Mailing address

5 Madison Avenue
Springfield, MA 01105
Phone (413) 733-6051

National Provider Directory

National Provider Directory
Tax ID family
Phoenix House10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5 Madison Ave
Springfield, MA 01105
Phone (413) 223-5834

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1422230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422230400000",
    "number": "1023408309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 MADISON AVENUE",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "01105",
            "telephone_number": "413-733-6051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 MADISON AVE",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011051403",
            "telephone_number": "413-733-6051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX HOUSE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-26",
        "last_updated": "2015-01-26",
        "status": "A",
        "authorized_official_last_name": "WALTMAN",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CLINICAL SUPERVISOR",
        "authorized_official_telephone_number": "413-355-6832",
        "authorized_official_credential": "MED,LMHC"
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "MA",
            "license": "745",
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "MA",
            "license": "745",
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MA",
            "license": "745",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.