NPIMap

Organization Active NPI

Phoenix Bridge Community Support

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Burlington, NC
National Provider Identifier
1508045998
Registry record updated Nov 1, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
MHL-001-121 Issued in NC
Legal business name
PHOENIX BRIDGE COMMUNITY SUPPORT
Practice address
814 Bradley St
Burlington, NC 27215-6806
Phone
(336) 222-8522
Fax
(336) 222-8533
NPI assigned
Nov 1, 2007
Organization subpart
Yes
Parent organization
PHOENIX BRIDGE GROUP HOME, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 1, 2007

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

Authorized official

Name
Miss Wendy Renee Jones
Title
Program Director
Phone
(336) 222-8522

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X MHL-001-121 NC Primary

Addresses

Primary practice location

814 Bradley St
Burlington, NC 27215-6806

Mailing address

909 A South Main Street
Burlington, NC 27215-5756
Phone (336) 222-8522

Other identifiers 1

IdentifierTypeStateIssuer
6603578MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Phoenix Bridge Community Services4 organizations share this tax ID, including this one
Part of
Phoenix Bridge Community Services

Other organizations with this tax ID 3

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1193875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193875200000",
    "number": "1508045998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 A SOUTH MAIN STREET",
            "city": "BURLINGTON",
            "state": "NC",
            "postal_code": "272155756",
            "telephone_number": "336-222-8522",
            "fax_number": "336-222-8533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "814 BRADLEY ST",
            "city": "BURLINGTON",
            "state": "NC",
            "postal_code": "272156806",
            "telephone_number": "336-222-8522",
            "fax_number": "336-222-8533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX BRIDGE COMMUNITY SUPPORT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PHOENIX BRIDGE GROUP HOME, INC.",
        "enumeration_date": "2007-11-01",
        "last_updated": "2007-11-01",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "WENDY",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "336-222-8522",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL-001-121",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603578",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burlington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2007; 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.