Phoenix Domus | |
114 Beech Ave Altoona PA 16601-4235 | |
(814) 502-5157 | |
Not Available |
Full Name | Phoenix Domus |
---|---|
Speciality | Counselor - Addiction (substance Use Disorder) |
Location | 114 Beech Ave, Altoona, Pennsylvania |
Authorized Official Name and Position | Gregory Alan Mcconnell (PROGRAM MANAGER) |
Authorized Official Contact | 8149346513 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Phoenix Domus 114 Beech Ave Altoona PA 16601-4235 Ph: (814) 502-5157 | Phoenix Domus 114 Beech Ave Altoona PA 16601-4235 Ph: (814) 502-5157 |
NPI Number | 1336728724 |
---|---|
Provider Enumeration Date | 04/05/2021 |
Last Update Date | 04/06/2021 |
Certification Date | 04/06/2021 |
Identifier | Type | State | Issuer |
---|---|---|---|
1336728724 | NPI | - | NPPES |
077037 | Medicaid | PA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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