PHOENIX HEALTH SERVICES, LLC (NPI# 1013932904) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013932904 |
| Entity Type | Organization |
| Organization Name | PHOENIX HEALTH SERVICES, LLC |
| Practice Address |
2021 Line Ave Shreveport LA 71104-2124 |
| Mailing Address |
8921 Mansfield Rd Shreveport LA 71118-2144 |
| Practice Telephone | 3182210661 |
| Practice Fax Number | 3182210662 |
| Mailing Telephone | 3186885416 |
| Mailing Fax Number | 3186885823 |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2008-08-08 |
| Authorized Official Name | DR. SURESH K DONEPUDI (OWNER) |
| Authorized Official Telephone | 3186885416 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962965319 | Phoenix Health Services, LLC | Skilled Nursing Facility | 23995 Wendover Dr, Beachwood, OH 44122-1552 | 2019-04-12 |
| Street Address |
2021 LINE AVE |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71104-2124 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326582263 | Dana Jackson | Counselor | 2425 Youree Drive, Shreveport, LA 71104 | 2016-12-12 |
| 1154772929 | Belena Cawthorne | Case Manager/Care Coordinator | 2040 Southern Ave, Shreveport, LA 71104 | 2016-06-23 |
| 1437505286 | Courtney Espenan | Counselor | 3825 Gilbert Dr Ste 124, Shreveport, LA 71104 | 2016-05-11 |
| 1215390497 | Joshua Mitchell | Counselor | 1106 Dalzell Street, Shreveport, LA 71104 | 2016-04-04 |
| 1699135426 | Amy Lutricia Krohn | Counselor | 1041 Dalzell St, Shreveport, LA 71104 | 2016-03-07 |
| 1225497779 | Annie Redding II | Counselor | 2525 Youree Dr Suite 110, Shreveport, LA 71104 | 2016-02-12 |
| 1891152328 | Council On Alcoholism and Drug Abuse of Northwest Louisiana | Community/Behavioral Health | 2000 Fairfield Ave, Shreveport, LA 71104 | 2016-01-28 |
| 1922465731 | Marteze Singleton | Case Manager/Care Coordinator | 2525 Youree Dr Ste 10, Shreveport, LA 71104 | 2016-01-25 |
| 1891160297 | Damara Mora | Counselor | 2620 Centenary Blvd Bldg3 Ste 312, Shreveport, LA 71104 | 2015-12-10 |
| 1962876250 | Chastity Shermaine Graham | Counselor | 2620 Centenary Blvd Ste 312, Shreveport, LA 71104 | 2015-11-24 |
| Find all providers in zip 71104 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063019156 | Johnson Behavioral Health Group | Clinic/Center | 4830 Line Ave Ste 302, Shreveport, LA 71106-1530 | 2020-10-02 |
| 1104479799 | Families First Counseling and Wellness, LLC | Clinic/Center | 2020 Hollywood Ave, Shreveport, LA 71108-3920 | 2019-07-22 |
| 1174087530 | Jl Counseling | Clinic/Center | 1545 Line Ave Ste 320e, Shreveport, LA 71101-4630 | 2019-01-29 |
| 1568948396 | Scere's Mediation & Counseling Services | Clinic/Center | 610 Marshall St Ste 625, Shreveport, LA 71101-3652 | 2018-07-16 |
| 1700384831 | Zodiac Holding Group | Clinic/Center | 3611 Greenway Pl, Shreveport, LA 71105-2011 | 2018-01-23 |
| 1235539644 | Envision Counseling Services LLC | Clinic/Center | 7505 Pines Rd Ste 1230, Shreveport, LA 71129-3900 | 2014-09-04 |
| 1457773657 | Comprehensive Assessments, Inc. | Clinic/Center | 3010 Knight St, Suite 125, Shreveport, LA 71105-2553 | 2014-01-08 |
| 1366687527 | Northwest Cmhc, L.L.C. | Clinic/Center | 2121 Fairfield Ave, Suite 210/220, Shreveport, LA 71104-2057 | 2008-12-02 |
| 1598950370 | Renaissance Healthcare LLC | Clinic/Center | 3321 Youree Dr, Suite 100, Shreveport, LA 71105-2123 | 2007-09-13 |
| 1568534857 | Community Enrichment Programs LLC | Clinic/Center | 842 Margaret Pl, Shreveport, LA 71101-4521 | 2006-11-14 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71104 |
Please comment or provide details below to improve the information on PHOENIX HEALTH SERVICES, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.