| Phoenix Llc | |
|
2226 5th Ave Council Bluffs IA 51501-3735 | |
| (402) 378-5755 | |
| Not Available |
| Full Name | Phoenix Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2226 5th Ave, Council Bluffs, Iowa |
| Authorized Official Name and Position | Joquana Shantay Goynes (CEO) |
| Authorized Official Contact | 4023785755 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Llc 2226 5th Ave Council Bluffs IA 51501-3735 Ph: (402) 378-5755 | Phoenix Llc 2226 5th Ave Council Bluffs IA 51501-3735 Ph: (402) 378-5755 |
| NPI Number | 1518793751 |
|---|---|
| Provider Enumeration Date | 09/13/2024 |
| Last Update Date | 09/13/2024 |
| Certification Date | 09/13/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518793751 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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