PHOENIX HOUSE FOUNDATION, INC. , NPI 1639247653 — NEW YORK (NY)

NPI 1639247653

13+ Years Experience Organization

PHOENIX HOUSE FOUNDATION, INC.

11/30/2006
PROVIDER ENUMERATION DATE
07.08.2007
LAST UPDATE DATE
1639247653
NPI NUMBER

About PHOENIX HOUSE FOUNDATION, INC.

PHOENIX HOUSE FOUNDATION, INC. is a provider established in NEW YORK, NY. The NPI number of PHOENIX HOUSE FOUNDATION, INC. is 1639247653 and was assigned on 11/30/2006. The practitioners primary taxonomy code is: 261QM1300X with license number: 7002298R NY .

Mailing address

  • City: BROOKLYN
  • State: NY
  • Postal code: 112011144
  • Phone: 7182226600
  • Fax: 7185762866
  • Address: 50 JAY ST
  • Address 2: 3RS FL

Primary Practice Address

  • Region : NEW YORK, NY
  • NPI : 1639247653
  • Phone : 7182226600
  • Fax : 7185762866
  • Postalcode : 100232301
  • Address : 164 W 74TH ST

Additional identifiers

  • Identifier: 371673
  • Code / Type : 5 - MEDICAID
  • Identifier state : NY

Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Provider taxonomy - Clinic/Center

  • Taxonomy code: 261QM1300X
  • License number: 7002298R
  • License state: NY

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Contacts:

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  • PHOENIX HOUSE FOUNDATION, INC.
  • Address : 164 W 74TH ST
  • Region : NEW YORK, NY
  • NPI : 1639247653
  • Phone : 7182226600
  • Fax : 7185762866
  • Postalcode : 100232301

Authorized official :

{:AUTHORIZED_OFFICIAL_FIRST_NAME:} {:AUTHORIZED_OFFICIAL_MIDDLE_NAME:} {:AUTHORIZED_OFFICIAL_LAST_NAME:}
  • Phone : 2125955810
  • Title or position : SR. VICE PRESIDENT, CFO

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address164 W 74TH ST
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameNEW YORK
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameNY
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code100232301
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number7182226600
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number7185762866
The fax number associated with the location address of the provider being identified.
NPI1639247653
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1261QM1300X
Provider Enumeration Date11/30/2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated07.08.2007
The date that a record was last updated or changed.
Entity TypeOrganization
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)PHOENIX HOUSE FOUNDATION, INC.
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address50 JAY ST
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Second Line Business Mailing Address3RS FL
The second line mailing address of the provider being identified. This data element may contain the same information as "Provider second line location address".
Provider Business Mailing Address City NameBROOKLYN
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameNY
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code112011144
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number7182226600
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number7185762866
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Authorized Official Last NameKIRCHOFF
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NameKEVIN
The first name of the authorized official
Authorized Official Title or PositionSR. VICE PRESIDENT, CFO
The title or position of the authorized official
Authorized Official Name Prefix TextMR.
Authorized Official Name Prefix Text
Authorized Official Telephone Number2125955810
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code #1261QM1300X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Clinic/Center
Provider License Number 17002298R
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1NY
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Other Provider Identifier 1371673
Other Provider Identifier #1
Other Provider Identifier Type 15
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 1NY
Other Provider Identifier State #1
X

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