| Phoenix Health Services, Llc | |
|
2021 Line Ave Shreveport LA 71104-2124 | |
| (318) 221-0661 | |
| (318) 221-0662 |
| Full Name | Phoenix Health Services, Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 2021 Line Ave, Shreveport, Louisiana |
| Authorized Official Name and Position | Suresh K Donepudi (OWNER) |
| Authorized Official Contact | 3186885416 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Health Services, Llc 8921 Mansfield Rd Shreveport LA 71118-2144 Ph: (318) 688-5416 | Phoenix Health Services, Llc 2021 Line Ave Shreveport LA 71104-2124 Ph: (318) 221-0661 |
| NPI Number | 1013932904 |
|---|---|
| Provider Enumeration Date | 07/13/2006 |
| Last Update Date | 08/08/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013932904 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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