Active NPI
Phoenix Place
- Community/Behavioral Health Agency
- Louisville, KY
National Provider Identifier
1740065713
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Behavioral Health Agency
- Legal business name
- PHOENIX PLACE
- Practice address
- 2012 W Chestnut St
Louisville, KY 40203-1542 - Phone
- (502) 656-9261
- NPI assigned
- Aug 29, 2023
- Organization subpart
- No
Authorized official
NPPES NPI Registry- Name
- Diamond Calloway
- Title
- Executive Director
- Phone
- (502) 656-9261
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 18D2308485 | Phoenix Place | Certificate of waiver | Jul 29, 2026 |
National Provider Directory
National Provider DirectorySpecialties & licenses 6
NPPES NPI Registry| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | |||
| Mental Health Counselor | 101YM0800X | |||
| Case Management Agency | 251B00000X | |||
| Community/Behavioral Health Agency | 251S00000X | Primary | ||
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | |||
| Children's Substance Abuse Rehabilitation Facility | 3245S0500X |
Addresses
NPPES NPI RegistryPrimary practice location
2012 W Chestnut St
Louisville, KY 40203-1542
Mailing address
2012 W Chestnut St
Louisville, KY 40203-1542
Phone (502) 656-9261
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 7, 2024.
{
"created_epoch": "1693267200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1715040000000",
"number": "1740065713",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2012 W CHESTNUT ST",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402031542",
"telephone_number": "502-656-9261"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2012 W CHESTNUT ST",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402031542",
"telephone_number": "502-656-9261"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PHOENIX PLACE",
"organizational_subpart": "NO",
"enumeration_date": "2023-08-29",
"last_updated": "2024-05-07",
"certification_date": "2024-05-07",
"status": "A",
"authorized_official_last_name": "CALLOWAY",
"authorized_official_first_name": "DIAMOND",
"authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
"authorized_official_telephone_number": "502-656-9261"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "251B00000X",
"taxonomy_group": "",
"desc": "Case Management",
"state": null,
"license": null,
"primary": false
},
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": null,
"license": null,
"primary": true
},
{
"code": "261QM0801X",
"taxonomy_group": "",
"desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
"state": null,
"license": null,
"primary": false
},
{
"code": "3245S0500X",
"taxonomy_group": "",
"desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.