Organization Active NPI

Phoenix Place

  • Community/Behavioral Health Agency
  • Louisville, KY
National Provider Identifier
1740065713
Registry record updated May 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
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 NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D2308485Phoenix Place2012 W Chestnut Street, Louisville, KY 40203Certificate of waiverJul 29, 2026

National Provider Directory

National Provider Directory

Specialties & licenses 6

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 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 Registry

Primary 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.

Verify at the official NPI Registry.