| Phoenix Risen, Llc | |
|
2112 Ratcliffe Ave Louisville KY 40210-2252 | |
| (804) 651-2688 | |
| Not Available |
| Full Name | Phoenix Risen, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2112 Ratcliffe Ave, Louisville, Kentucky |
| Authorized Official Name and Position | Chiquita Conner (OWNER) |
| Authorized Official Contact | 8046512688 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Risen, Llc 6709 Rebecca Ln Louisville KY 40258-3011 Ph: (804) 651-2688 | Phoenix Risen, Llc 2112 Ratcliffe Ave Louisville KY 40210-2252 Ph: (804) 651-2688 |
| NPI Number | 1750117784 |
|---|---|
| Provider Enumeration Date | 09/09/2024 |
| Last Update Date | 09/09/2024 |
| Certification Date | 09/08/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750117784 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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