NPIMap

Organization Active NPI

Phoenix House of New England

  • Community/Behavioral Health Agency
  • Wakefield, RI
National Provider Identifier
1790804292
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
00100 Issued in RI
Legal business name
PHOENIX HOUSE OF NEW ENGLAND
Practice address
1058 Kingstown Rd
Wakefield, RI 02879-2487
Phone
(401) 783-0782
Fax
(401) 783-1154
NPI assigned
Mar 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Reynard Lorin Bullock, MS LMFT
Title
Counselor
Phone
(401) 783-0782

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 00100 RI Primary

Addresses

Primary practice location

1058 Kingstown Rd
Wakefield, RI 02879-2487

Mailing address

1058 Kingstown Rd
Wakefield, RI 02879-2487
Phone (401) 783-0782

National Provider Directory

National Provider Directory
Tax ID family
Phoenix House10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1790804292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1058 KINGSTOWN RD",
            "city": "WAKEFIELD",
            "state": "RI",
            "postal_code": "028792487",
            "telephone_number": "401-783-0782",
            "fax_number": "401-783-1154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1058 KINGSTOWN RD",
            "city": "WAKEFIELD",
            "state": "RI",
            "postal_code": "028792487",
            "telephone_number": "401-783-0782",
            "fax_number": "401-783-1154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX HOUSE OF NEW ENGLAND",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BULLOCK",
        "authorized_official_first_name": "REYNARD",
        "authorized_official_middle_name": "LORIN",
        "authorized_official_title_or_position": "COUNSELOR",
        "authorized_official_telephone_number": "401-783-0782",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MS LMFT"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "RI",
            "license": "00100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wakefield, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.