NPIMap

Organization Active NPI

Phoenix Therapeutic Foundation, Inc

  • Community/Behavioral Health Agency
  • Baltimore, MD
National Provider Identifier
1033247945
Registry record updated Sep 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
D0016432 Issued in MD
Legal business name
PHOENIX THERAPEUTIC FOUNDATION, INC
Practice address
5602 Baltimore National Pike
Suite 700
Baltimore, MD 21228-1411
Phone
(410) 744-9100
Fax
(410) 747-0226
NPI assigned
Mar 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2012

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

Authorized official

Name
Amr A Elbeshir, M.A.
Title
Program Director Ceo
Phone
(410) 744-9100

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YA0400X LCA149 MD
Mental Health CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YM0800X LC1148 MD
Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 104100000X G08008 MD
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X 11349 MD
Community/Behavioral Health Agency 251S00000X D0016432 MD Primary

Addresses

Primary practice location

5602 Baltimore National Pike
Suite 700
Baltimore, MD 21228-1411

Mailing address

5602 Baltimore National Pike
Suite 700
Baltimore, MD 21228-1411
Phone (410) 744-9100

Other identifiers 1

IdentifierTypeStateIssuer
403344200MedicaidMD

National Provider Directory

National Provider Directory
Tax ID family
Phoenix Therapeutic Foundation3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348704000000",
    "number": "1033247945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5602 BALTIMORE NATIONAL PIKE",
            "address_2": "SUITE 700",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212281411",
            "telephone_number": "410-744-9100",
            "fax_number": "410-747-0226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5602 BALTIMORE NATIONAL PIKE",
            "address_2": "SUITE 700",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212281411",
            "telephone_number": "410-744-9100",
            "fax_number": "410-747-0226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX THERAPEUTIC FOUNDATION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2012-09-27",
        "status": "A",
        "authorized_official_last_name": "ELBESHIR",
        "authorized_official_first_name": "AMR",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR CEO",
        "authorized_official_telephone_number": "410-744-9100",
        "authorized_official_credential": "M.A."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MD",
            "license": "LCA149",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "MD",
            "license": "LC1148",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": "MD",
            "license": "G08008",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "11349",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MD",
            "license": "D0016432",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "403344200",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2012; 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.