| Heart Of The Phoenix, Llc | |
|
1422 N Hancock Ave Ste 1 Colorado Springs CO 80903 | |
| (719) 331-3721 | |
| Not Available |
| Full Name | Heart Of The Phoenix, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1422 N Hancock Ave Ste 1, Colorado Springs, Colorado |
| Authorized Official Name and Position | Wendy Carter (OWNER) |
| Authorized Official Contact | 7193313721 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Heart Of The Phoenix, Llc 1422 N Hancock Ave Ste 1 Colorado Springs CO 80903-2641 Ph: (719) 331-3721 | Heart Of The Phoenix, Llc 1422 N Hancock Ave Ste 1 Colorado Springs CO 80903 Ph: (719) 331-3721 |
| NPI Number | 1356828297 |
|---|---|
| Provider Enumeration Date | 07/24/2018 |
| Last Update Date | 08/23/2018 |
| Medicare PECOS PAC ID | 1951655935 |
|---|---|
| Medicare Enrollment ID | O20181109000914 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356828297 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Wendy Jean Carter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609163021 PECOS PAC ID: 9133433857 Enrollment ID: I20150807014769 |
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