| Phoenix Llc | |
|
4919 Brambleton Ave Roanoke VA 24018-4149 | |
| (540) 685-4298 | |
| (540) 685-4299 |
| Full Name | Phoenix Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4919 Brambleton Ave, Roanoke, Virginia |
| Authorized Official Name and Position | Ashley Callahan (OWNER) |
| Authorized Official Contact | 5406854298 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Llc 4919 Brambleton Ave Roanoke VA 24018-4149 Ph: (540) 685-4298 | Phoenix Llc 4919 Brambleton Ave Roanoke VA 24018-4149 Ph: (540) 685-4298 |
| NPI Number | 1700297876 |
|---|---|
| Provider Enumeration Date | 05/12/2014 |
| Last Update Date | 01/20/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700297876 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 1910-03-001 (Virginia) | Primary |
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