NPIMap

Organization Active NPI

Phoenix House Foundation

  • Substance Abuse Rehabilitation Facility
  • Brentwood, NY
National Provider Identifier
1336464965
Registry record updated Apr 7, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
080833-1 Issued in NY
Legal business name
PHOENIX HOUSE FOUNDATION
Practice address
998 Crooked Hill Rd
Building 5
Brentwood, NY 11717-1019
Phone
(631) 306-5740
Fax
(631) 306-5885
NPI assigned
Apr 7, 2010
Last updated
Apr 7, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2010

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

Authorized official

Name
Mr. Elan Daniel Robin, LMSW
Title
Senior Counselor
Phone
(631) 306-5770

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X 080833-1 NY Primary

Addresses

Primary practice location

998 Crooked Hill Rd
Building 5
Brentwood, NY 11717-1019

Mailing address

998 Crooked Hill Rd
Building 5
Brentwood, NY 11717-1019
Phone (631) 306-5740

National Provider Directory

National Provider Directory
Tax ID family
Community Programs Inc3 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.

Locations

998 Crooked Hill Rd
Bldg 5
Brentwood, NY 11717
Phone (631) 521-8400

NPI Registry JSON

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

{
    "created_epoch": "1270598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1270598400000",
    "number": "1336464965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "998 CROOKED HILL RD",
            "address_2": "BUILDING 5",
            "city": "BRENTWOOD",
            "state": "NY",
            "postal_code": "117171019",
            "telephone_number": "631-306-5740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "998 CROOKED HILL RD",
            "address_2": "BUILDING 5",
            "city": "BRENTWOOD",
            "state": "NY",
            "postal_code": "117171019",
            "telephone_number": "631-306-5740",
            "fax_number": "631-306-5885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX HOUSE FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-07",
        "last_updated": "2010-04-07",
        "status": "A",
        "authorized_official_last_name": "ROBIN",
        "authorized_official_first_name": "ELAN",
        "authorized_official_middle_name": "DANIEL",
        "authorized_official_title_or_position": "SENIOR COUNSELOR",
        "authorized_official_telephone_number": "631-306-5770",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LMSW"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NY",
            "license": "080833-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brentwood, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2010; 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.