NPIMap

Organization Active NPI

Phoenix Adolescent Outpatient Treatment

  • Community/Behavioral Health Agency
  • Maplewood, MN
National Provider Identifier
1588833271
Registry record updated Feb 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
1048347-1-CDT Issued in MN
Legal business name
PHOENIX ADOLESCENT OUTPATIENT TREATMENT
Practice address
2055 White Bear Ave N
Maplewood, MN 55109-3716
Phone
(651) 734-3268
Fax
(612) 378-4886
NPI assigned
Feb 27, 2008
Last updated
Feb 27, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
PHOENIX GROUP HOMES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 27, 2008

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

Authorized official

Name
Mr. Howard Louis Meier Jr., LADC
Title
Executive Director
Phone
(651) 230-1895

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 1048347-1-CDT MN Primary

Addresses

Primary practice location

2055 White Bear Ave N
Maplewood, MN 55109-3716

Mailing address

1011 Interlachen Pkwy
Woodbury, MN 55125-8852
Phone (651) 230-0849

National Provider Directory

National Provider Directory
Tax ID family
Phoenix Recovery Programs Inc7 organizations share this tax ID, including this one
Part of
Phoenix Recovery Programs Inc

Other organizations with this tax ID 6

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

Locations

2055 White Bear Ave N
Maplewood, MN 55109
Phone (651) 209-0560

NPI Registry JSON

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

{
    "created_epoch": "1204070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204070400000",
    "number": "1588833271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 INTERLACHEN PKWY",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551258852",
            "telephone_number": "651-230-0849",
            "fax_number": "651-773-5894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2055 WHITE BEAR AVE N",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551093716",
            "telephone_number": "651-734-3268",
            "fax_number": "612-378-4886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX ADOLESCENT OUTPATIENT TREATMENT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PHOENIX GROUP HOMES, INC.",
        "enumeration_date": "2008-02-27",
        "last_updated": "2008-02-27",
        "status": "A",
        "authorized_official_last_name": "MEIER",
        "authorized_official_first_name": "HOWARD",
        "authorized_official_middle_name": "LOUIS",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "651-230-1895",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "LADC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MN",
            "license": "1048347-1-CDT",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maplewood, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2008; 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.