NPIMap

Organization Active NPI

Phoenix Therapeutic Foundation

  • Community/Behavioral Health Agency
  • Baltimore, MD
National Provider Identifier
1336333079
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
Practice address
5602 Baltimore National Pike
Suburbia BLDG - Suite # 508/6
Baltimore, MD 21228-1411
Phone
(410) 744-9100
Fax
(410) 747-0226
NPI assigned
Sep 5, 2007
Organization subpart
Yes
Parent organization
PHOENIX THERAPEUTIC FOUNDATIONAs reported in NPPES

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
Mr. Amr A El-Beshir, M.A.
Title
Ceo/Program Director
Phone
(410) 744-9100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X D0016432 MD Primary

Addresses

Primary practice location

5602 Baltimore National Pike
Suburbia BLDG - Suite # 508/6
Baltimore, MD 21228-1411

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
401254200MedicaidMD

National Provider Directory

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

Other organizations with this tax ID 2

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

Locations

5602 Baltimore National Pike
Ste 5086
Baltimore, MD 21228
Phone (410) 744-9100

NPI Registry JSON

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

{
    "created_epoch": "1188950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348704000000",
    "number": "1336333079",
    "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": "SUBURBIA BLDG - SUITE # 508/6",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212281411",
            "telephone_number": "410-744-9100",
            "fax_number": "410-747-0226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX THERAPEUTIC FOUNDATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PHOENIX THERAPEUTIC FOUNDATION",
        "enumeration_date": "2007-09-05",
        "last_updated": "2012-09-27",
        "status": "A",
        "authorized_official_last_name": "EL-BESHIR",
        "authorized_official_first_name": "AMR",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO/PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "410-744-9100",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.A."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MD",
            "license": "D0016432",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "401254200",
            "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.