PHOENIX HOUSE INC. (NPI# 1861529398) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861529398 |
| Entity Type | Organization |
| Organization Name | PHOENIX HOUSE INC. |
| Practice Address |
8916 Woodhall Lake Dr Waxhaw NC 28173-6800 |
| Practice Telephone | 7045367931 |
| Mailing Telephone | 7045367931 |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | LESLIE TAYLOR (DIRECTOR) |
| Authorized Official Telephone | 7045367931 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | MHL-060-651 | NC | Residential Treatment Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841464492 | Phoenix House Inc. | Substance Abuse Rehabilitation Facility | 57467 Waterworks St, Calumet, MI 49913-1258 | 2008-04-15 |
| Street Address |
8916 WOODHALL LAKE DR |
| City | WAXHAW |
| State | NC |
| Zip Code | 28173-6800 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942394101 | Phoenix House, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 8916 Woodhall Lake Dr, Waxhaw, NC 28173-6800 | 2006-10-03 |
| 1699196535 | Ralph Taylor | Counselor | 8916 Woodhall Lake Dr, Waxhaw, NC 28173-6800 | 2013-12-19 |
| 1710308648 | Leslie Taylor | Social Worker | 8916 Woodhall Lake Dr, Waxhaw, NC 28173-6800 | 2013-12-19 |
| 1053586065 | Phoenix House Child Agency | Custodial Care Facility | 8916 Woodhall Lake Dr, Waxhaw, NC 28173-6800 | 2008-04-30 |
| 1124164405 | Phoenix House, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 8916 Woodhall Lake Dr, Waxhaw, NC 28173-6800 | 2007-01-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033733175 | Publix North Carolina, Lp | Durable Medical Equipment & Medical Supplies | 1615 Providence Road South, Marvin, NC 28173 | 2020-06-04 |
| 1225507320 | Shane Markey Dds Ms Pllc | Dentist | 8412 New Town Rd Ste A, Waxhaw, NC 28173 | 2018-11-19 |
| 1336631514 | Suganya Nelatoor,d.d.s.,p.l.l.c. | Clinic/Center | 102 E Waxhaw Professional Park Drive, Waxhaw, NC 28173 | 2018-06-04 |
| 1184120750 | Restore Healthcare Medical Group | Counselor | 500 Waxhaw Professional Park Drive, Ste 105 F, Waxhaw, NC 28173 | 2018-04-03 |
| 1730690827 | Concrete Roses Consulting | Community/Behavioral Health | 5960 Fairview Road, 323, Charlotte, NC 28173 | 2017-10-17 |
| 1861849523 | Kayla Selena Caldwell | Social Worker | 3908 Rev. H. Morrison Rd., Waxhaw, NC 28173 | 2016-05-23 |
| 1588023782 | Teri Hipp | Counselor | 101-e Waxhaw Professional Park Drive, Waxhaw, NC 28173 | 2016-02-16 |
| 1710355508 | Caresmatic Phase 1,inc. | Assisted Living Facility | 520 Pembroke Ln., Waxhaw, NC 28173 | 2015-09-10 |
| 1437564838 | Anna Waddell Schneiderman | Counselor | 104 Waxhaw Professional Park Drive, Waxhaw, NC 28173 | 2014-06-24 |
| 1467892109 | Samantha Weidele Waldman | Counselor | 9929 Rea Rd Ste 201, Waxhaw, NC 28173 | 2013-06-26 |
| Find all providers in zip 28173 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942394101 | Phoenix House, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 8916 Woodhall Lake Dr, Waxhaw, NC 28173-6800 | 2006-10-03 |
| 1124164405 | Phoenix House, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 8916 Woodhall Lake Dr, Waxhaw, NC 28173-6800 | 2007-01-30 |
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|---|---|---|---|---|
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| 1457998627 | Re Health Group | Residential Treatment Facility, Emotionally Disturbed Children | 1102 Groves St, Kings Mountain, NC 28086-2232 | 2019-12-05 |
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| 1699233866 | A Brighter Path LLC | Residential Treatment Facility, Emotionally Disturbed Children | 120 Jetter Rd, Grover, NC 28073-9687 | 2019-03-06 |
| 1821562224 | Carter Clinic, Pa | Residential Treatment Facility, Emotionally Disturbed Children | 703 W 3rd Ave Bldg A, Red Springs, NC 28377-1524 | 2019-01-18 |
| 1659842607 | Gervonia Robinson | Residential Treatment Facility, Emotionally Disturbed Children | 1714 Aster Ln, Gastonia, NC 28054-8303 | 2018-12-16 |
| 1679058440 | Miracle Houses Inc | Residential Treatment Facility, Emotionally Disturbed Children | 7827 Kerrybrook Cir, Charlotte, NC 28214-2513 | 2018-09-27 |
| 1174048078 | A Safe Place Community Housing, LLC | Residential Treatment Facility, Emotionally Disturbed Children | 2049 Highland St, Charlotte, NC 28208-4909 | 2017-08-11 |
| 1104346881 | Inspiration for Us | Residential Treatment Facility, Emotionally Disturbed Children | 1205 W Mountain St, Kernersville, NC 27284-2173 | 2017-06-22 |
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| 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.