NPIMap

Organization Active NPI

Phoenix LLC

  • Community/Behavioral Health Agency
  • Roanoke, VA
National Provider Identifier
1700297876
Registry record updated Jan 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
1910-03-001 Issued in VA
Legal business name
PHOENIX LLC
Practice address
4919 Brambleton Ave
Roanoke, VA 24018-4149
Phone
(540) 685-4298
Fax
(540) 685-4299
NPI assigned
May 12, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2015

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

Authorized official

Name
Ashley Callahan, PHD
Title
Owner
Phone
(540) 685-4298

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 1910-03-001 VA Primary

Addresses

Primary practice location

4919 Brambleton Ave
Roanoke, VA 24018-4149

Mailing address

4919 Brambleton Ave
Roanoke, VA 24018-4149
Phone (540) 685-4298

National Provider Directory

National Provider Directory

Locations

4919 Brambleton Ave
Roanoke, VA 24018
Phone (540) 685-4298

4919 Brambleton Ave
Ste 200
Roanoke, VA 24018

235 Claiborne Ave
Ste 200
Rocky Mount, VA 24151
Phone (540) 238-2080

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1399852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421712000000",
    "number": "1700297876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4919 BRAMBLETON AVE",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240184149",
            "telephone_number": "540-685-4298",
            "fax_number": "540-685-4299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4919 BRAMBLETON AVE",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240184149",
            "telephone_number": "540-685-4298",
            "fax_number": "540-685-4299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-12",
        "last_updated": "2015-01-20",
        "status": "A",
        "authorized_official_last_name": "CALLAHAN",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "540-685-4298",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "VA",
            "license": "1910-03-001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2015; 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.