NPIMap

Organization Active NPI

Phoenix Bridge Community Services

  • Case Management Agency
  • Burlington, NC
National Provider Identifier
1619158227
Registry record updated Nov 26, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Management AgencyTaxonomy code 251B00000X
Legal business name
PHOENIX BRIDGE COMMUNITY SERVICES
Practice address
909A South Main Street
Burlington, NC 27215
Phone
(336) 222-8522
Fax
(336) 222-8533
NPI assigned
Nov 26, 2007
Organization subpart
Yes
Parent organization
PHOENIX BRIDGE GROUP HOMES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 26, 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
Case Management Agency 251B00000X Primary

Addresses

Primary practice location

909A South Main Street
Burlington, NC 27215

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
8301363MedicaidNC

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.

NPI Registry JSON

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

{
    "created_epoch": "1196035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196035200000",
    "number": "1619158227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909A SOUTH MAIN STREET",
            "city": "BURLINGTON",
            "state": "NC",
            "postal_code": "27215",
            "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": "909A SOUTH MAIN STREET",
            "city": "BURLINGTON",
            "state": "NC",
            "postal_code": "27215",
            "telephone_number": "336-222-8522",
            "fax_number": "336-222-8533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX BRIDGE COMMUNITY SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PHOENIX BRIDGE GROUP HOMES, INC.",
        "enumeration_date": "2007-11-26",
        "last_updated": "2007-11-26",
        "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": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301363",
            "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 26, 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.