The Phoenix Group, LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

489DLC-456043 Issued in IA

Legal business name

THE PHOENIX GROUP, LLC

Doing business as

The Phoenix Group

Practice address

200 S 37TH St Apt F
Council Bluffs, IA 51501-3284

Phone

(712) 355-8665

NPI assigned

May 1, 2013

Organization subpart

No

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

Authorized official

Name

Mr. Keith Duane McMillen

Title

Operations Director

Phone

(712) 355-8665

Specialties & licenses 1

Addresses

Other names 1

• The Phoenix Group Doing business as

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

{
    "created_epoch": "1367366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404864000000",
    "number": "1518302801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 S 37TH ST APT F",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515013284",
            "telephone_number": "712-355-8665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 S 37TH ST APT F",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515013284",
            "telephone_number": "712-355-8665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PHOENIX GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-01",
        "last_updated": "2014-07-09",
        "status": "A",
        "authorized_official_last_name": "MCMILLEN",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "DUANE",
        "authorized_official_title_or_position": "OPERATIONS DIRECTOR",
        "authorized_official_telephone_number": "712-355-8665",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "IA",
            "license": "489DLC-456043",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Phoenix Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Council Bluffs, IA
• Providers in Council Bluffs, IA by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2014; 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.