| Phoenix Academy | |
|
160b N San Pedro Rd Rm 7 And Rm9 San Rafael CA 94903-4206 | |
| (415) 491-0218 | |
| Not Available |
| Full Name | Phoenix Academy |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 160b N San Pedro Rd, San Rafael, California |
| Authorized Official Name and Position | Donald Bruce Blasky (CHIEF PROGRAM OFFICER) |
| Authorized Official Contact | 4157552311 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Academy 171 Carlos Dr San Rafael CA 94903-2005 Ph: (415) 444-5580 | Phoenix Academy 160b N San Pedro Rd Rm 7 And Rm9 San Rafael CA 94903-4206 Ph: (415) 491-0218 |
| NPI Number | 1326221565 |
|---|---|
| Provider Enumeration Date | 12/11/2007 |
| Last Update Date | 08/02/2021 |
| Certification Date | 08/02/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326221565 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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