Phoenix Residential Services

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

License

AS630244869 Issued in MI

Legal business name

PHOENIX RESIDENTIAL SERVICES

Practice address

108 Franklin Blvd
Pontiac, MI 48341-1706

Phone

(248) 338-3743

NPI assigned

May 11, 2017

Organization subpart

No

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

Authorized official

Name

Demetra B Leonard

Title

President

Phone

(248) 338-3743

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1494460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494460800000",
    "number": "1912434770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 FRANKLIN BLVD",
            "city": "PONTIAC",
            "state": "MI",
            "postal_code": "483411706",
            "telephone_number": "248-338-3743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 FRANKLIN BLVD",
            "city": "PONTIAC",
            "state": "MI",
            "postal_code": "483411706",
            "telephone_number": "248-338-3743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX RESIDENTIAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-11",
        "last_updated": "2017-05-11",
        "status": "A",
        "authorized_official_last_name": "LEONARD",
        "authorized_official_first_name": "DEMETRA",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-338-3743"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "MI",
            "license": "AS630244869",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brandon Quach Pham, DO
• Duc Duy Pham, DDS
• Briana Phillips
• Robert Melvin Phillips Jr., MD
• Shawna Phillips
• Physical Therapy Management Mi LLC
• Rahul Pidikiti, MD
• Delince Pierre-Louis
• Jamie Pietila
• Kimberly Ann Pike-Moesta, NURSE PRACTITIONER

• Mental Illness Community Based Residential Treatment Facility in Pontiac, MI
• Providers in Pontiac, MI by specialty
• Mental Illness Community Based Residential Treatment Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2017; 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.