NPIMap

Organization Active NPI

Phoenix House, Inc

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Waxhaw, NC
National Provider Identifier
1942394101
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
322D00000X Issued in NC
Legal business name
PHOENIX HOUSE, INC
Practice address
8916 Woodhall Lake Dr
Waxhaw, NC 28173-6800
Phone
(704) 536-7931
NPI assigned
Oct 3, 2006
Last updated
Aug 22, 2020By the provider in NPPES
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
Leslie TaylorNPI 1710308648
Title
Director
Phone
(704) 536-7931

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X 322D00000X NC Primary

Addresses

Primary practice location

8916 Woodhall Lake Dr
Waxhaw, NC 28173-6800

Mailing address

8916 Woodhall Lake Dr
Waxhaw, NC 28173-6800
Phone (704) 536-7931

Other identifiers 1

IdentifierTypeStateIssuer
6603417MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Phoenix House Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1942394101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8916 WOODHALL LAKE DR",
            "city": "WAXHAW",
            "state": "NC",
            "postal_code": "281736800",
            "telephone_number": "704-536-7931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8916 WOODHALL LAKE DR",
            "city": "WAXHAW",
            "state": "NC",
            "postal_code": "281736800",
            "telephone_number": "704-536-7931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX HOUSE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "704-536-7931"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "322D00000X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603417",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waxhaw, NC

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.