NPIMap

Organization Active NPI

Phoenix House, Inc

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Charlotte, NC
National Provider Identifier
1447396718
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
Legal business name
PHOENIX HOUSE, INC
Practice address
7800 Pence Pond LN
Charlotte, NC 28227-2449
Phone
(704) 536-7931
NPI assigned
Jan 30, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Leslie Taylor
Title
Director
Phone
(704) 536-7931

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X NU Primary

Addresses

Primary practice location

7800 Pence Pond LN
Charlotte, NC 28227-2449

Mailing address

8916 Woodhall Lake Dr
Waxhaw, NC 28173-6800
Phone (704) 536-7931

Other identifiers 1

IdentifierTypeStateIssuer
6603175MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Phoenix House Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1447396718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8916 WOODHALL LAKE DR",
            "city": "WAXHAW",
            "state": "NC",
            "postal_code": "281736800",
            "telephone_number": "704-536-7931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7800 PENCE POND LN",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282272449",
            "telephone_number": "704-536-7931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX HOUSE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "704-536-7931",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603175",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.