| Green Phoenix | |
|
3154 Memorial Hwy Ste 100 Dallas PA 18612-9203 | |
| (570) 855-9404 | |
| Not Available |
| Full Name | Green Phoenix |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 3154 Memorial Hwy Ste 100, Dallas, Pennsylvania |
| Authorized Official Name and Position | Amanda Leah Rodriguez Rogers (OWNER) |
| Authorized Official Contact | 5708559404 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Green Phoenix 2182 State Route 29 Hwy Hunlock Creek PA 18621-4512 Ph: (570) 239-8052 | Green Phoenix 3154 Memorial Hwy Ste 100 Dallas PA 18612-9203 Ph: (570) 855-9404 |
| NPI Number | 1023875010 |
|---|---|
| Provider Enumeration Date | 03/05/2024 |
| Last Update Date | 08/26/2024 |
| Certification Date | 08/26/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023875010 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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